Balasubramanyam Sadhana, O'Donnell Barrett P, Musher Benjamin L, Jhaveri Pavan M, Ludwig Michelle S
John P. and Katherine G. McGovern Medical School, Houston, TX, USA.
Baylor College of Medicine, Houston, TX, USA.
J Gastrointest Cancer. 2019 Jun;50(2):244-253. doi: 10.1007/s12029-018-0054-y.
OBJECTIVE(S): The objective of this study was to characterize the clinicopathological prognostic factors and treatment patterns for small cell carcinoma (SCC) of the colon, a rare disease without standard treatment guidelines.
We analyzed clinicopathological and treatment variables for 503 cases of histologically proven SCC colon entered into the National Cancer Database (NCDB) between 2004 and 2013. Survival curves were generated using Kaplan-Meier and compared by the log-rank test. Cox proportional hazard regression was used to control for covariates and evaluate the effect of different treatment modalities on overall survival.
Four hundred seventy-two (93.8%) patients had complete clinical staging information and were therefore included in our analysis. Of these patients, 149 (31.5%) had limited stage disease (LD) and 323 (68.4%) had extensive stage disease (ED) at presentation. Median overall survival (OS) for patients with ED was significantly lower than for those with LD (4.04 months vs. 21.82 months; p < 0.001). Multivariate Cox regression analysis showed administration of chemotherapy was associated with improved survival in patients with LD and ED (p = 0.026, p < 0.001) while surgery was not associated with improved survival in patients with LD or ED (p = 0.943, p = 0.630). Radiation therapy was associated with improved survival in patients with ED (p = 0.044).
SCC of the colon carries a poor prognosis, especially in patients presenting with metastatic disease. Surgery and chemotherapy are administered more frequently than radiation, and chemotherapy is associated with improved survival, unlike surgery.
本研究的目的是明确结肠小细胞癌（SCC）的临床病理预后因素及治疗模式，结肠小细胞癌是一种罕见疾病，尚无标准治疗指南。
我们分析了2004年至2013年间录入国家癌症数据库（NCDB）的503例经组织学证实的结肠SCC患者的临床病理和治疗变量。采用Kaplan-Meier法生成生存曲线，并通过对数秩检验进行比较。使用Cox比例风险回归来控制协变量，并评估不同治疗方式对总生存的影响。
472例（93.8%）患者有完整的临床分期信息，因此纳入我们的分析。在这些患者中，149例（31.5%）初诊时为局限性疾病（LD），323例（68.4%）为广泛性疾病（ED）。ED患者的中位总生存（OS）显著低于LD患者（4.04个月对21.82个月；p＜0.001）。多因素Cox回归分析显示，化疗与LD和ED患者的生存改善相关（p = 0.026，p＜0.001），而手术与LD或ED患者的生存改善无关（p = 0.943，p = 0.630）。放射治疗与ED患者的生存改善相关（p = 0.044）。
结肠SCC预后较差，尤其是出现转移性疾病的患者。手术和化疗的应用比放疗更频繁，与手术不同，化疗与生存改善相关。
