Mori Takeo, Hirota Teruyuki, Ohashi Yasuo, Kodaira Susumu
Department of Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
Dis Colon Rectum. 2006 Jul;49(7):982-92. doi: 10.1007/s10350-006-0531-4.
This study was designed to investigate whether the histologic types of the primary lesion and of metastatic lymph nodes in Stage III colon cancer are useful as prognostic factors. The usefulness of adjuvant chemotherapy in a randomized, controlled trial by using these prognostic factors as stratification criteria was also investigated.
Stage III colon cancer patients were enrolled and were divided into two groups: Group W, in which the histologic type of both primary tumors and metastatic lymph nodes was well-differentiated adenocarcinoma; and Group U, in which the primary tumors and the metastatic lymph nodes were of any type other than well-differentiated. Group W patients were assigned to Treatment Arm A (surgery alone) or Arm B (surgery, then 1-hexylcarbamoyl-5-fluorouracil); and Group U patients, to Treatment Arm C (same as B), and Arm D (surgery + 1-hexylcarbamoyl-5-fluorouracil + mitomycin C).
The Group W five-year survival rate was significantly superior to that in Group U (P = 0.0035). There was a better survival rate in Treatment Arm A than Arm B (P = 0.0321), but no difference between Treatment Arms C and D.
In Stage III colon cancer, the prognosis of cases whose primary lesion and lymph node tissues are both well differentiated is extremely good. In such cases, it is possible for adjuvant chemotherapy to have a deleterious effect, and therefore, it is not recommended.
本研究旨在调查Ⅲ期结肠癌原发灶和转移淋巴结的组织学类型是否可作为预后因素。还研究了以这些预后因素作为分层标准在随机对照试验中辅助化疗的有效性。
纳入Ⅲ期结肠癌患者并分为两组：W组，原发肿瘤和转移淋巴结的组织学类型均为高分化腺癌；U组，原发肿瘤和转移淋巴结为除高分化腺癌以外的任何类型。W组患者被分配至治疗A组（单纯手术）或B组（手术，然后使用1-己基氨基甲酰基-5-氟尿嘧啶）；U组患者被分配至治疗C组（与B组相同）和D组（手术 + 1-己基氨基甲酰基-5-氟尿嘧啶 + 丝裂霉素C）。
W组的五年生存率显著高于U组（P = 0.0035）。治疗A组的生存率高于B组（P = 0.0321），但治疗C组和D组之间无差异。
在Ⅲ期结肠癌中，原发灶和淋巴结组织均为高分化的病例预后极佳。在此类病例中，辅助化疗可能产生有害作用，因此不建议使用。
