Division of Abdomino-Pelvic and Minimally Invasive Surgery, European Institute of Oncology, Via G. Ripamonti, 435, 20141, Milan, Italy.
Int J Colorectal Dis. 2013 Feb;28(2):207-15. doi: 10.1007/s00384-012-1563-y. Epub 2012 Aug 19.
For patients with Stage II colon cancer, the use of adjuvant chemotherapy remains controversial. The purpose of this study was to identify clinical and/or pathological findings related to a worse prognosis in this category of patients.
We retrospectively analyzed the data of consecutive patients, extracted by an institutional Tumour Registry, admitted to an affiliated University Hospital in Milan (European Institute of Oncology) for adenocarcinoma of the colon (all sites), between 2000 and 2005, and having a final pT3 N0 pathology staging after curative surgery. Adjuvant chemotherapy was decided as a result of a medical decision within a multidisciplinary Tumor Board.
Data of 137 patients were obtained, with a median follow-up of 77 months (range 6-131). Patients who received chemotherapy were younger than patients who did not. Nine patients out of 137 (6.5 %) died as a consequence of colon cancer recurrence; four of them had received adjuvant chemotherapy. Only histological grade III and mucinous histotype were found to impact on cumulative incidence of colon-related events (p 0.03 and 0.02, respectively); no impact was found on cumulative incidence of colonic neoplasm recurrence-related deaths (p 0.74 and 0.74, respectively). Number of analyzed LNs (lymph nodes) emerged as a factor possibly affecting the cumulative incidence of colon-related events (p 0.09) as well as the cumulative incidence of colonic neoplasm recurrence-related deaths (p 0.10). The risk of events was inversely proportional to the number of dissected LNs, even over 20 up to about 25 LNs. Never-smokers exhibited a lower incidence of colon-related events, although the difference was not statistically significant (p 0.09). All other analyzed variables did not show any impact on survival rate, including age, gender, ASA score, BMI, site of colonic neoplasm, multifocality, perivascular invasion, and use of adjuvant chemotherapy.
Histology grading G3 and mucinous histotype were predictors of worse outcome. Efforts to improve LN evaluation should result in clinically significant improvements in outcome, and also the quality of care for patients with radically resected stage II colon cancer.
对于 II 期结肠癌患者，辅助化疗的应用仍存在争议。本研究旨在确定与该类患者预后较差相关的临床和/或病理发现。
我们回顾性分析了 2000 年至 2005 年间在米兰附属大学医院（欧洲肿瘤研究所）因结肠癌（所有部位）入院并接受根治性手术后最终病理分期为 pT3N0 的连续患者的机构肿瘤登记处提取的数据。辅助化疗是多学科肿瘤委员会医疗决策的结果。
共获得 137 例患者的数据，中位随访时间为 77 个月（范围 6-131）。接受化疗的患者比未接受化疗的患者年轻。137 例患者中有 9 例（6.5%）死于结肠癌复发；其中 4 例接受了辅助化疗。仅组织学分级 III 和黏液组织类型被发现对结直肠癌相关事件的累积发生率有影响（p 分别为 0.03 和 0.02）；对结直肠肿瘤复发相关死亡的累积发生率无影响（p 分别为 0.74 和 0.74）。分析的淋巴结（lymph nodes）数量被认为是可能影响结直肠癌相关事件累积发生率（p 0.09）和结直肠肿瘤复发相关死亡累积发生率（p 0.10）的因素。事件风险与解剖淋巴结的数量成反比，即使在 20 个以上到大约 25 个淋巴结。从不吸烟者结直肠癌相关事件的发生率较低，但差异无统计学意义（p 0.09）。包括年龄、性别、ASA 评分、BMI、结直肠肿瘤部位、多灶性、血管周围侵犯和辅助化疗在内的所有其他分析变量均未显示对生存率有任何影响。
组织学分级 G3 和黏液组织类型是预后不良的预测因素。努力改善淋巴结评估应导致临床显著改善预后，也改善了根治性切除 II 期结肠癌患者的治疗质量。
