Son Il Tae, Ahn Soyeon, Park Kyu Joo, Oh Jae Hwan, Jeong Seung-Yong, Park Hyoung-Chul, Heo Seung Chul, Youk Eui Gon, Park Jin-Taek, Ihn Myong Hoon, Oh Heung-Kwon, Kim Duck-Woo, Lee Kyoung Ho, Kang Sung-Bum
Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, South Korea.
Surg Oncol. 2016 Mar;25(1):37-43. doi: 10.1016/j.suronc.2015.12.006. Epub 2015 Dec 30.
There has been no comparative study of the long-term oncological outcomes of appendiceal cancer and colon cancer. We hypothesized that the oncological outcome is worse in appendiceal cancer because perforation is more frequent than in colon cancer.
Patients with stage I-III were selected from 5046 patients with appendiceal or colon cancer, between September 2001 and June 2010. The 5-year disease-free survival (DFS) was the primary endpoint. Multivariate analyses with Cox proportional hazards model for DFS and logistic regression model for perforation were conducted. A matching model was used to compensate for the heterogeneity between groups.
The perforation rate was 44.7% in appendiceal cancer (n = 47), but 1.1% in colon cancer (n = 2828) (p = 0.001). The 5-year DFS rate was lower in appendiceal cancer than in colon cancer (57.9% vs. 85.2%, p = 0.001; matching model, 54.2% vs. 78.4%, p = 0.038), with a higher rate of peritoneal seeding (25.5% vs. 2.5%, p = 0.001; matching model, 24.0% vs. 4.0%, p = 0.007). Multivariate Cox regression showed that appendiceal cancer was an independent prognostic factor for poor DFS (hazard ratio = 2.602, 95% confidence interval = 1.26-5.35, p = 0.009), and logistic regression confirmed that appendiceal cancer was the risk factor associated with perforation (odds ratio = 66.265, 95% confidence interval = 28.21-155.61, p = 0.001).
This study suggested that the long-term oncological outcomes are worse for appendiceal cancer than for colon cancer, attributed to higher perforation rate in appendiceal cancer.
目前尚无关于阑尾癌和结肠癌长期肿瘤学结局的比较研究。我们推测，由于阑尾癌穿孔比结肠癌更频繁，其肿瘤学结局更差。
从2001年9月至2010年6月期间的5046例阑尾癌或结肠癌患者中选取I-III期患者。5年无病生存率（DFS）为主要终点。采用Cox比例风险模型对DFS进行多变量分析，采用逻辑回归模型对穿孔进行分析。使用匹配模型来弥补组间的异质性。
阑尾癌的穿孔率为44.7%（n = 47），而结肠癌为1.1%（n = 2828）（p = 0.001）。阑尾癌的5年DFS率低于结肠癌（57.9%对85.2%，p = 0.001；匹配模型，54.2%对78.4%，p = 0.038），腹膜种植率更高（25.5%对2.5%，p = 0.001；匹配模型，24.0%对4.0%，p = 0.007）。多变量Cox回归显示，阑尾癌是DFS不良的独立预后因素（风险比 = 2.602，95%置信区间 = 1.26 - 5.35，p = 0.009），逻辑回归证实阑尾癌是与穿孔相关的危险因素（优势比 = 66.265，95%置信区间 = 28.
