Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
J Surg Oncol. 2013 Nov;108(6):358-63. doi: 10.1002/jso.23407. Epub 2013 Aug 23.
The usefulness of adjuvant chemotherapy (CMT) in patients with Stage IIA colon cancer remains unclear. The present study aimed to investigate extramural extension as an indicator for adjuvant CMT. Data were reviewed from 202 consecutive patients with Stage IIA colon cancer that underwent curative surgery between 1995 and 2007. The distance of the extramural extension (DEE) was measured histologically. The optimal prognostic cut-off point of the DEE for oncologic outcomes was statistically determined. The eligible surviving patients had been followed for a median period of 75 months (range: 2-210 months). Patients were subdivided into two groups according to the optimal cut-off point; DEE ≤5 mm (pT3a) and DEE >5 mm (pT3b). The pT3b was the most powerful independent risk factor for postoperative recurrence (P = 0.0324, HR: 3.04, 95% CI: 1.098-8.408), and was significantly correlated with distant metastasis (P = 0.0161 HR: 5.19, 95% CI: 1.765-15.239). The recurrence-free and cancer-specific 5-year survival rates in patients with pT3b were significantly lower than in patients with pT3a (81.5% vs. 95.4%, P = 0.0003 and 85.9% vs. 97.4%, P = 0.0007, respectively). pT3b could be an important risk factor for distant metastasis in Stage IIA colon cancer. Postoperative adjuvant CMT may be indicated for patients with pT3b.
辅助化疗（CMT）在 IIA 期结肠癌患者中的作用仍不清楚。本研究旨在探讨壁外延伸作为辅助 CMT 的指标。对 1995 年至 2007 年间接受根治性手术的 202 例 IIA 期结肠癌患者的资料进行了回顾性分析。组织学测量壁外延伸距离（DEE）。统计学确定 DEE 对肿瘤学结果的最佳预后截断点。对符合条件的存活患者进行了中位随访 75 个月（范围：2-210 个月）。根据最佳截断点将患者分为两组；DEE≤5mm（pT3a）和 DEE＞5mm（pT3b）。pT3b 是术后复发的最强独立危险因素（P=0.0324，HR：3.04，95%CI：1.098-8.408），并与远处转移显著相关（P=0.0161，HR：5.19，95%CI：1.765-15.239）。pT3b 患者的无复发生存率和癌症特异性 5 年生存率明显低于 pT3a 患者（81.5% vs. 95.4%，P=0.0003 和 85.9% vs. 97.4%，P=0.0007）。pT3b 可能是 IIA 期结肠癌远处转移的重要危险因素。术后辅助 CMT 可能适用于 pT3b 患者。
