Quah Hak-Mien, Chou Joanne F, Gonen Mithat, Shia Jinru, Schrag Deborah, Landmann Ron G, Guillem José G, Paty Philip B, Temple Larissa K, Wong W Douglas, Weiser Martin R
Colorectal Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Dis Colon Rectum. 2008 May;51(5):503-7. doi: 10.1007/s10350-008-9246-z. Epub 2008 Mar 6.
Adjuvant therapy for Stage II colon cancer remains controversial but may be considered for patients with high-risk features. The purpose of this study was to assess the prognostic significance of commonly reported clinicopathologic features of Stage II colon cancer to identify high-risk patients.
We analyzed a prospectively maintained database of patients with colon cancer who underwent surgical treatment from 1990 to 2001 at a single specialty center. We identified 448 patients with Stage II colon cancer who had been treated by curative resection alone, without postoperative chemotherapy.
With median follow-up of 53 months, 5-year disease-specific survival for this cohort was 91 percent. Univariate and multivariate analyses identified three independent features that significantly affected disease-specific survival: tumor Stage T4 (hazard ratio (HR), 2.7; 95 percent confidence interval (CI), 1.1-6.2; P = 0.02), preoperative carcinoembryonic antigen > 5 ng/ml (HR, 2.1; 95 percent CI, 1.1-4.1; P = 0.02), and presence of lymphovascular or perineural invasion (HR, 2.1; 95 percent CI, 1-4.4; P = 0.04). Five-year disease-specific survival for patients without any of the above poor prognostic features was 95 percent; five-year disease-specific survival for patients with one of these poor prognostic features was 85 percent; and five-year disease-specific survival for patients with > or = 2 poor prognostic features was 57 percent.
Patients with Stage II colon cancer generally have an excellent prognosis. However, the presence of multiple adverse prognostic factors identifies a high-risk subgroup. Use of commonly reported clinicopathologic features accurately stratifies Stage II colon cancer by disease-specific survival. Those identified as high-risk patients can be considered for adjuvant chemotherapy and/or enrollment in investigational trials.
II期结肠癌的辅助治疗仍存在争议，但具有高危特征的患者可考虑接受辅助治疗。本研究的目的是评估II期结肠癌常见临床病理特征的预后意义，以识别高危患者。
我们分析了一个前瞻性维护的数据库，该数据库收录了1990年至2001年在单一专科中心接受手术治疗的结肠癌患者。我们确定了448例仅接受根治性切除且未接受术后化疗的II期结肠癌患者。
中位随访53个月，该队列的5年疾病特异性生存率为91%。单因素和多因素分析确定了三个显著影响疾病特异性生存的独立特征：肿瘤分期T4（风险比[HR]，2.7；95%置信区间[CI]，1.1 - 6.2；P = 0.02）、术前癌胚抗原>5 ng/ml（HR，2.1；95%CI，1.1 - 4.1；P = 0.02）以及存在淋巴管或神经周围侵犯（HR，2.1；95%CI，1 - 4.4；P = 0.04）。没有上述任何不良预后特征的患者5年疾病特异性生存率为95%；具有其中一个不良预后特征的患者5年疾病特异性生存率为85%；具有≥2个不良预后特征的患者5年疾病特异性生存率为57%。
II期结肠癌患者总体预后良好。然而，存在多个不良预后因素可识别出高危亚组。使用常见的临床病理特征可根据疾病特异性生存准确地对II期结肠癌进行分层。被确定为高危的患者可考虑接受辅助化疗和/或参加临床试验。
