Mroczkowski Pawel, Schmidt Uwe, Sahm Maik, Gastinger Ingo, Lippert Hans, Kube Rainer
Department of General, Visceral and Vascular Surgery, Otto-von-Guericke-University of Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
World J Surg. 2012 Jul;36(7):1693-8. doi: 10.1007/s00268-012-1531-2.
We focused on the risk factors for poor outcome after curative resection of a colon cancer in UICC stages I and II based on the data of the Germany-wide quality assurance study "colon/rectum cancer (primary tumor)." In some countries, all stage II colon cancer patients are encouraged to participate in a clinical trial. We feel that this approach is too broad.
Using the data of 15,096 patients operated on from January 1, 2000 to December 31, 2004, the following factors were analyzed with the Cox regression model: age, comorbidities, ASA score, gender, localization of the tumor (left colon vs. right colon), perioperative complications (yes/no), pT stage, grading (G1/G2 vs. G3/G4), L-status (lymph vessels invasion yes/no), and V-status (venous invasion yes/no).
The probability of a local relapse in stages I and II was 1.5 and 4.6%, respectively, or distant metastases 4.7 and 10.2%, respectively. Only pT stage [hazard ratio (HR) for pT1 = 1, pT2 = 1.821, pT3 = 2.735, and pT4 = 5.881], L-status (HR for L1 = 1.393), age (HR per year = 1.021), as well as ASA score IV (HR = 4.536) had significant influence on tumor-free survival.
Despite favorable prognosis and R0 resection, a small percentage of patients will still relapse. The most important risk factor comprising the tumor-free survival is the pT stage followed by L-status and age. These results should be taken into consideration when determining the course for adjuvant chemotherapy, especially if the course includes the recommendation of clinical trial participation for stage II colon cancer patients after an R0 resection.
基于德国范围内的“结肠癌/直肠癌（原发肿瘤）”质量保证研究数据，我们聚焦于国际抗癌联盟（UICC）I期和II期结肠癌根治性切除术后预后不良的危险因素。在一些国家，鼓励所有II期结肠癌患者参加临床试验。我们认为这种方法过于宽泛。
利用2000年1月1日至2004年12月31日期间接受手术的15096例患者的数据，采用Cox回归模型分析以下因素：年龄、合并症、美国麻醉医师协会（ASA）评分、性别、肿瘤部位（左半结肠与右半结肠）、围手术期并发症（是/否）、pT分期、分级（G1/G2与G3/G4）、L状态（淋巴管侵犯是/否）和V状态（静脉侵犯是/否）。
I期和II期局部复发的概率分别为1.5%和4.6%，远处转移的概率分别为4.7%和10.2%。只有pT分期[pT1的风险比（HR）=1，pT2 = 1.821，pT3 = 2.735，pT4 = 5.881]、L状态（L1的HR = 1.393）、年龄（每年HR = 1.021）以及ASA评分IV（HR = 4.536）对无瘤生存有显著影响。
尽管预后良好且为R0切除，但仍有一小部分患者会复发。构成无瘤生存的最重要危险因素是pT分期，其次是L状态和年龄。在确定辅助化疗方案时应考虑这些结果，尤其是当方案包括建议R0切除术后的II期结肠癌患者参加临床试验时。
