Spindler Blake A, Bergquist John R, Thiels Cornelius A, Habermann Elizabeth B, Kelley Scott R, Larson David W, Mathis Kellie L
Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55902, USA.
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
J Gastrointest Surg. 2017 May;21(5):770-777. doi: 10.1007/s11605-017-3391-4. Epub 2017 Mar 13.
High-risk features are used to direct adjuvant therapy for stage II colon cancer. Currently, high-risk features are identified postoperatively, limiting preoperative risk stratification. We hypothesized carcinoembryonic antigen (CEA) can improve preoperative risk stratification for stage II colon cancer. The National Cancer Database (NCDB 2004-2009) was reviewed for stage II colon adenocarcinoma patients undergoing curative intent resection. A novel risk stratification including both traditional high-risk features (T4 lesion, <12 lymph nodes sampled, and poor differentiation) and elevated CEA was developed. Unadjusted Kaplan-Meier and adjusted Cox proportional hazards analyzed overall survival. Concordance Probability Estimates (CPE) assessed discrimination. Seventy-four thousand nine hundred forty-five patients were identified; 40,844 (54.5%) had CEA levels reported and were included. Chemotherapy administration was similar between normal and elevated CEA groups (23.8 vs. 25.1%, p = 0.003). Compared to patients with CEA elevation, 5-year overall survival in patients with normal CEA was improved (74.5 vs. 63.4%, p < 0.001). Restratification incorporating CEA resulted in reclassification of 6912 patients (16.9%) from average to high risk. CPE increased for novel risk stratification (0.634 vs. 0.612, SE = 0.005). The routinely available CEA test improved risk stratification for stage II colon cancer. CEA not only may improve staging of colon cancer but may also help guide additional therapy.
高危特征用于指导II期结肠癌的辅助治疗。目前，高危特征是在术后确定的，这限制了术前风险分层。我们假设癌胚抗原（CEA）可以改善II期结肠癌的术前风险分层。我们回顾了国家癌症数据库（NCDB 2004 - 2009）中接受根治性切除的II期结肠腺癌患者。开发了一种新的风险分层方法，该方法包括传统的高危特征（T4病变、采样淋巴结<12个以及低分化）和CEA升高。未调整的Kaplan - Meier分析和调整后的Cox比例风险模型分析了总生存期。一致性概率估计（CPE）评估了鉴别能力。共识别出74945例患者；其中40844例（54.5%）报告了CEA水平并被纳入研究。正常CEA组和CEA升高组之间的化疗给药情况相似（23.8%对25.1%，p = 0.003）。与CEA升高的患者相比，CEA正常的患者5年总生存期有所改善（74.5%对63.4%，p < 0.001）。纳入CEA的重新分层导致6912例患者（16.9%）从平均风险重新分类为高风险。新风险分层的CPE增加（0.634对0.612，SE = 0.005）。常规可用的CEA检测改善了II期结肠癌的风险分层。CEA不仅可能改善结肠癌的分期，还可能有助于指导额外的治疗。
