结直肠癌中的DNA倍体状态与预后：已发表数据的荟萃分析

DNA ploidy status and prognosis in colorectal cancer: a meta-analysis of published data.

作者信息

Araujo Sergio E A, Bernardo Wanderley M, Habr-Gama Angelita, Kiss Desiderio R, Cecconello Ivan

机构信息

Department of Gastroenterology, Surgical Division, University of Sao Paulo Medical School, Cristiano Viana 450, ap 62, 05411 - 000, Sao Paulo, Brazil.

出版信息

Dis Colon Rectum. 2007 Nov;50(11):1800-10. doi: 10.1007/s10350-007-9013-6.

DOI:10.1007/s10350-007-9013-6

PMID:17874166

Abstract

PURPOSE

In colorectal cancer, the negative effect of aneuploidy has been a controversy for more than 20 years. Studies to determine a survival-deoxyribonucleic acid content relationship have conflicting results. A systematic literature search followed by a meta-analysis of published studies addressing prognostic effect of aneuploidy for patients who underwent surgical treatment of colon and rectal cancer was conducted.

METHODS

The main outcome measure was the five-year overall mortality rate after surgical resection. For the selected studies, we estimated this outcome for three subsets of patients through separate meta-analyses: 1) for all patients with colorectal cancer; 2) only between patients with Stage II colon cancer; and 3) only for studies in which follow-up losses were declared. The presence of publication bias was assessed with a funnel plot for asymmetry.

RESULTS

A total of 5,478 patients with colorectal cancer were represented in 32 studies (Group 1), we estimated a reduction in the five-year overall mortality from 43.2 percent for aneuploid tumors to 29.2 percent for diploid tumors (combined relative risk = 1.44; 95 percent confidence interval = 1.34-1.55; P < 0.001). In addition, 357 patients with Stage II colon cancer (Group 2) extracted from three studies had an absolute reduction of 14.3 percent in five-year overall mortality favoring diploid tumors (combined relative risk = 1.93; 95 percent confidence interval = 1.29-2.89; P = 0.001). Lastly, of 14 studies in which follow-up losses were declared (Group 3), 2,221 patients were represented and a 15.7 percent mortality reduction was measured favoring patients with diploid tumors (combined relative risk = 1.44; 95 percent confidence interval = 1.3-1.61; P < 0.001).

CONCLUSIONS

Patients who undergo an aneuploid colorectal cancer surgical resection have a higher risk of death after five years. This finding may ultimately impact survival of patients with node-negative colon cancer through adjuvant therapy.

摘要

目的

在结直肠癌中，非整倍体的负面影响已争论了20多年。确定生存与脱氧核糖核酸含量关系的研究结果相互矛盾。我们进行了系统的文献检索，随后对已发表的关于非整倍体对接受结肠和直肠癌手术治疗患者预后影响的研究进行了荟萃分析。

方法

主要结局指标是手术切除后的五年总死亡率。对于所选研究，我们通过单独的荟萃分析估计了三组患者的这一结局：1）所有结直肠癌患者；2）仅II期结肠癌患者之间；3）仅针对声明有随访失访情况的研究。通过漏斗图不对称性评估发表偏倚的存在。

结果

32项研究纳入了总共5478例结直肠癌患者（第1组），我们估计非整倍体肿瘤的五年总死亡率从43.2%降至二倍体肿瘤的29.2%（合并相对风险=1.44；95%置信区间=1.34 - 1.55；P<0.001）。此外，从三项研究中提取的357例II期结肠癌患者（第2组），五年总死亡率绝对降低了14.3%，二倍体肿瘤更具优势（合并相对风险=1.93；95%置信区间=1.29 - 2.89；P = 0.001）。最后，在声明有随访失访情况的14项研究（第3组）中，纳入了2221例患者，二倍体肿瘤患者的死亡率降低了15.7%（合并相对风险=1.44；95%置信区间=1.3 - 1.61；P<0.001）。