完整结肠系膜切除术与传统结肠癌手术的无病生存比较：一项回顾性、基于人群的研究。

Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study.

机构信息

Department of Surgery, Hillerød University Hospital, Hillerød, University of Copenhagen, Copenhagen, Denmark.

出版信息

Lancet Oncol. 2015 Feb;16(2):161-8. doi: 10.1016/S1470-2045(14)71168-4. Epub 2014 Dec 31.

DOI:10.1016/S1470-2045(14)71168-4

PMID:25555421

Abstract

BACKGROUND

Application of the principles of total mesorectal excision to colon cancer by undertaking complete mesocolic excision (CME) has been proposed to improve oncological outcomes. We aimed to investigate whether implementation of CME improved disease-free survival compared with conventional colon resection.

METHODS

Data for all patients who underwent elective resection for Union for International Cancer Control (UICC) stage I-III colon adenocarcinomas in the Capital Region of Denmark between June 1, 2008, and Dec 31, 2011, were retrieved for this population-based study. The CME group consisted of patients who underwent CME surgery in a centre validated to perform such surgery; the control group consisted of patients undergoing conventional colon resection in three other hospitals. Data were collected from the Danish Colorectal Cancer Group (DCCG) database and medical charts. Patients were excluded if they had stage IV disease, metachronous colorectal cancer, rectal cancer (≤ 15 cm from anal verge) in the absence of synchronous colon adenocarcinoma, tumour of the appendix, or R2 resections. Survival data were collected on Nov 13, 2014, from the DCCG database, which is continuously updated by the National Central Office of Civil Registration.

FINDINGS

The CME group consisted of 364 patients and the non-CME group consisted of 1031 patients. For all patients, 4-year disease-free survival was 85.8% (95% CI 81.4-90.1) after CME and 75.9% (72.2-79.7) after non-CME surgery (log-rank p=0.0010). 4-year disease-free survival for patients with UICC stage I disease in the CME group was 100% compared with 89.8% (83.1-96.6) in the non-CME group (log-rank p=0.046). For patients with UICC stage II disease, 4-year disease-free survival was 91.9% (95% CI 87.2-96.6) in the CME group compared with 77.9% (71.6-84.1) in the non-CME group (log-rank p=0.0033), and for patients with UICC stage III disease, it was 73.5% (63.6-83.5) in the CME group compared with 67.5% (61.8-73.2) in the non-CME group (log-rank p=0.13). Multivariable Cox regression showed that CME surgery was a significant, independent predictive factor for higher disease-free survival for all patients (hazard ratio 0.59, 95% CI 0.42-0.83), and also for patients with UICC stage II (0.44, 0.23-0.86) and stage III disease (0.64, 0.42-1.00). After propensity score matching, disease-free survival was significantly higher after CME, irrespective of UICC stage, with 4-year disease-free survival of 85.8% (95% CI 81.4-90.1) after CME and 73.4% (66.2-80.6) after non-CME (log-rank p=0·0014).

INTERPRETATION

Our data indicate that CME surgery is associated with better disease-free survival than is conventional colon cancer resection for patients with stage I-III colon adenocarcinoma. Implementation of CME surgery might improve outcomes for patients with colon cancer.

FUNDING

Tvergaards Fund and Edgar and Hustru Gilberte Schnohrs Fund.

摘要

背景

通过实施完整结肠系膜切除术（CME）将结直肠癌的原则应用于全直肠系膜切除术中，被认为可以改善肿瘤学结果。我们旨在研究 CME 是否比传统的结肠癌切除术改善无病生存率。

方法

这项基于人群的研究从丹麦首都地区 2008 年 6 月 1 日至 2011 年 12 月 31 日期间接受国际癌症控制联盟（UICC）I-III 期结肠腺癌选择性切除术的所有患者的数据中进行了检索。CME 组包括在经过验证可进行此类手术的中心接受 CME 手术的患者；对照组包括在另外三家医院接受常规结肠癌切除术的患者。数据从丹麦结直肠癌组（DCCG）数据库和病历中收集。如果患者患有 IV 期疾病、同时性结直肠癌、距肛门 15cm 以内的直肠肿瘤（无同时性结肠癌）、阑尾肿瘤或 R2 切除术，则将其排除在外。2014 年 11 月 13 日，从 DCCG 数据库收集了生存数据，该数据库由国家中央公民登记处不断更新。

结果

CME 组有 364 例患者，非 CME 组有 1031 例患者。对于所有患者，CME 手术后的 4 年无病生存率为 85.8%（95%CI 81.4-90.1），而非 CME 手术后为 75.9%（72.2-79.7）（对数秩检验 p=0.0010）。CME 组 UICC Ⅰ期疾病患者的 4 年无病生存率为 100%，而非 CME 组为 89.8%（83.1-96.6）（对数秩检验 p=0.046）。对于 UICC Ⅱ期疾病患者，CME 组的 4 年无病生存率为 91.9%（95%CI 87.2-96.6），而非 CME 组为 77.9%（71.6-84.1）（对数秩检验 p=0.0033），对于 UICC Ⅲ期疾病患者，CME 组为 73.5%（63.6-83.5），而非 CME 组为 67.5%（61.8-73.2）（对数秩检验 p=0.13）。多变量 Cox 回归显示，CME 手术是所有患者无病生存率更高的显著独立预测因素（风险比 0.59，95%CI 0.42-0.83），也是 UICC Ⅱ期（0.44，0.23-0.86）和 III 期疾病（0.64，0.42-1.00）患者的独立预测因素。在倾向评分匹配后，CME 后的无病生存率显著更高，无论 UICC 分期如何，CME 后的 4 年无病生存率为 85.8%（95%CI 81.4-90.1），而非 CME 后的 73.4%（66.2-80.6）（对数秩检验 p=0.0014）。