Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Eur J Cancer. 2009 Nov;45(17):2992-9. doi: 10.1016/j.ejca.2009.07.008. Epub 2009 Aug 12.
Adjuvant therapy is not routinely recommended in UICC stages I and II colon cancer, but may be considered for high-risk patients. Our aim is to identify clinicopathologic characteristics in colon cancer stages I and II, which are associated with an increased risk of tumour recurrence and tumour-related death.
We analysed our prospectively documented clinical database of 775 patients with colon cancer stages I and II, which underwent curative resection between 1982 and 2006. No adjuvant chemotherapy was applied. The median follow-up time was 80 months.
For the entire study group, 5- and 10-year tumour-specific survival probabilities were 94.8+/-0.9% and 91.0+/-1.4%, respectively. Multivariate analysis identified three tumour characteristics as independent prognostic factors: lymphatic vessel invasion (p=0.034), poor tumour grading (G3/G4) (p=0.020) and extended tumour length (6 cm) (p=0.042). Five-year (10-year) tumour-specific survival for patients without any of the poor prognostic tumour characteristics (ppTCs) was 96.0% (94.7%). There was a significantly increased risk for tumour-related death with increasing numbers of ppTCs (p<0.001). While patients with only one ppTC had a 5-year (10-year) tumour-specific survival of 94.8% (88.9%), it decreased to 88.9% (78.4%) for patients with two ppTCs (hazard ratio (HR) 3.69, 95% confidence interval (CI) 1.67-8.13) and to 87.5% (72.9%) for patients with all three ppTCs (HR 6.56, 95% CI 1.50-26.62).
Patients with stage I or II colon cancer have a favourable prognosis after radical resection. The presence of two or three poor prognostic tumour characteristics identifies a small patient subgroup (12%) with an increased risk of tumour-related death that may be considered for adjuvant chemotherapy.
辅助治疗通常不推荐用于 UICC Ⅰ期和Ⅱ期结肠癌，但可能适用于高危患者。我们的目的是确定Ⅰ期和Ⅱ期结肠癌中与肿瘤复发和肿瘤相关死亡风险增加相关的临床病理特征。
我们分析了我们前瞻性记录的 775 例Ⅰ期和Ⅱ期结肠癌患者的临床数据库，这些患者在 1982 年至 2006 年间接受了根治性切除术。未应用辅助化疗。中位随访时间为 80 个月。
对于整个研究组，5 年和 10 年肿瘤特异性生存率分别为 94.8±0.9%和 91.0±1.4%。多变量分析确定了三个肿瘤特征为独立的预后因素：淋巴管浸润（p=0.034）、肿瘤分级差（G3/G4）（p=0.020）和肿瘤长度扩展（6cm）（p=0.042）。没有任何不良预后肿瘤特征（ppTCs）的患者 5 年（10 年）肿瘤特异性生存率为 96.0%（94.7%）。随着 ppTCs 数量的增加，肿瘤相关死亡的风险显著增加（p<0.001）。虽然仅有一个 ppTC 的患者 5 年（10 年）肿瘤特异性生存率为 94.8%（88.9%），但有两个 ppTCs 的患者下降至 88.9%（78.4%）（风险比（HR）3.69，95%置信区间（CI）1.67-8.13），有三个 ppTCs 的患者下降至 87.5%（72.9%）（HR 6.56，95%CI 1.50-26.62）。
根治性切除后，Ⅰ期或Ⅱ期结肠癌患者的预后良好。存在两个或三个不良预后肿瘤特征可识别出一小部分（12%）肿瘤相关死亡风险增加的患者，可能考虑辅助化疗。
