Ghiringhelli Francois, Hennequin Audrey, Drouillard Antoine, Lepage Côme, Faivre Jean, Bouvier Anne-Marie
Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France; National Institute of Health and Medical Research, INSERM, UMR-866 University of Burgundy, Dijon, France.
Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France.
Dig Liver Dis. 2014 Sep;46(9):854-8. doi: 10.1016/j.dld.2014.05.011. Epub 2014 Jun 5.
Epidemiological data on synchronous and metachronous metastatic colon cancer are scarce. We assessed epidemiological characteristics and survival in synchronous and metachronous metastatic colon cancer in a French population.
Our study included 932 cases of metastatic colon cancer diagnosed in 1999-2010 and registered in a population-based cancer registry; 758 were synchronous colon metastases and 174 metachronous metastases from resected primary colon cancers diagnosed in 1999-2005. Univariate relative survival was calculated and a multivariate model with proportional hazard applied to net survival by interval was used.
Mean age at diagnosis was 71.1 years for patients with metachronous metastasis and 71.4 years for those with synchronous metastasis (p=0.818). Patients with metachronous metastasis were more likely to have R0 resection (Odds Ratio: 3.05 [1.96-4.76], p<0.001) than patients with synchronous metastasis. Five-year relative survival was 7.2% for synchronous metastasis and 17.6% for metachronous metastasis (p<0.001), but did not differ significantly for patients with R0 resection (47.3% and 61.5% respectively, p=0.120). For patients not receiving chemotherapy risk of death was significantly lower in the metachronous metastasis group (Hazard Ratio=0.44 [0.32-0.60], p<0.001).
On a population basis, synchronous metastasis is an independent poor prognostic factor in colon cancer. Chemotherapy and resection of all metastatic sites significantly improved the outcome in patients with synchronous metastasis.
关于同时性和异时性转移性结肠癌的流行病学数据稀缺。我们评估了法国人群中同时性和异时性转移性结肠癌的流行病学特征及生存率。
我们的研究纳入了1999年至2010年诊断出并登记在基于人群的癌症登记处的932例转移性结肠癌病例；其中758例为同时性结肠转移，174例为1999年至2005年诊断出的原发性结肠癌切除术后的异时性转移。计算单变量相对生存率，并使用应用了比例风险的多变量模型来分析按时间间隔的净生存率。
异时性转移患者的诊断时平均年龄为71.1岁，同时性转移患者为71.4岁（p = 0.818）。与同时性转移患者相比，异时性转移患者更有可能进行R0切除（优势比：3.05 [1.96 - 4.76]，p < 0.001）。同时性转移的五年相对生存率为7.2%，异时性转移为17.6%（p < 0.001），但R0切除的患者之间差异不显著（分别为47.3%和61.5%，p = 0.120）。对于未接受化疗的患者，异时性转移组的死亡风险显著较低（风险比 = 0.44 [0.32 - 0.60]，p < 0.001）。
在人群层面，同时性转移是结肠癌独立的不良预后因素。化疗和切除所有转移部位显著改善了同时性转移患者的预后。
