Sternberg A, Sibirsky O, Cohen D, Blumenson L E, Rodriguez-Bigas M A, Petrelli N J
Department of Surgery, Sackler School of Medicine, Tel Aviv University, Israel.
Ann Surg Oncol. 1999 Mar;6(2):161-5. doi: 10.1007/s10434-999-0161-x.
Future developments in adjuvant modalities may require substaging of node-positive colorectal adenocarcinoma that is accurately indicative of individual prognoses, upon which therapeutic decisions (e.g., choice of agents and intensity of treatment) may be based. This study compares substaging of node-positive colorectal cancer by venous invasion with substaging by three currently used methods, with respect to the ability of each method to define patient subsets that differ significantly in both disease-free and cancer-related survival rates.
A total of 171 patients with node-positive colorectal cancer, who had undergone potentially curative resection at least 5 years earlier, were retrospectively substaged by the tumor, node, metastasis (TNM) N1/N2, Astler-Coller C1/C2, Gastrointestinal Tumor Study Group (GITSG) C1/C2, and venous invasion (positive/negative) methods. Disease-free and cancer-related survival curves were calculated (by the Kaplan-Meier method) and compared for statistical significance (using the log-rank test).
The separation of disease-free and cancer-related survival curves using the four methods of substaging node-positive colorectal cancer was as follows: TNM, P = .16 (not significant) and P = .12 (not significant); Astler-Coller, P < .01 and P = .006; GITSG, P = .067 (not significant) and P = .03; venous invasion, P = .016 and P = .007, respectively.
Numerical substaging of node-positive colorectal cancer (TNM and GITSG methods) is an inferior predictor of prognosis, compared with substaging by the T value (Astler-Coller) or venous invasion methods. We think that the latter method is the method of choice, because it separates patients who have only lymphatic metastasis from patients who display microscopic hematogenous spread as well. This separation obviously has biological/oncological significance, and it may have practical therapeutic implications in the future.
辅助治疗方式的未来发展可能需要对淋巴结阳性的结肠直肠癌进行亚分期，这种亚分期要能准确反映个体预后，从而为治疗决策（如药物选择和治疗强度）提供依据。本研究比较了通过静脉侵犯对淋巴结阳性结肠癌进行亚分期与通过三种目前使用的方法进行亚分期的情况，比较了每种方法界定在无病生存率和癌症相关生存率方面有显著差异的患者亚组的能力。
对至少在5年前接受了根治性切除的171例淋巴结阳性结肠癌患者，采用肿瘤、淋巴结、转移（TNM）N1/N2、阿斯特勒-科勒C1/C2、胃肠道肿瘤研究组（GITSG）C1/C2以及静脉侵犯（阳性/阴性）方法进行回顾性亚分期。计算无病生存率和癌症相关生存率曲线（采用Kaplan-Meier法），并比较其统计学显著性（采用对数秩检验）。
使用四种淋巴结阳性结肠癌亚分期方法对无病生存率和癌症相关生存率曲线进行区分的结果如下：TNM法，P = 0.16（无显著性差异）和P = 0.12（无显著性差异）；阿斯特勒-科勒法，P < 0.01和P = 0.006；GITSG法，P = 0.067（无显著性差异）和P = 0.03；静脉侵犯法，P分别为0.016和0.007。
与通过T值（阿斯特勒-科勒法）或静脉侵犯法进行亚分期相比，淋巴结阳性结肠癌的数字亚分期（TNM法和GITSG法）对预后的预测能力较差。我们认为后一种方法是首选方法，因为它能将仅发生淋巴转移的患者与也显示有微小血行播散的患者区分开来。这种区分显然具有生物学/肿瘤学意义，并且未来可能具有实际的治疗意义。
