Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Biostatistics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Dis Colon Rectum. 2018 Apr;61(4):461-471. doi: 10.1097/DCR.0000000000001022.
Although colorectal cancer comprises several histological subtypes, the influences of histological subtypes on disease progression and treatment responses remain controversial.
We sought to evaluate the prognostic relevance of mucinous and poorly differentiated histological subtypes of colorectal cancer by the propensity score weighting analysis of prospectively collected data from multi-institute phase III trials.
Independent patient data analysis of a pooled database from 3 phase III trials was performed.
An integrated database of 3 multicenter prospective clinical trials (the Japanese Foundation for Multidisciplinary Treatment of Cancer 7, 15, and 33) was the source of study data.
Surgery alone or postoperative adjuvant chemotherapy was offered in patients with resectable colorectal cancer.
To balance essential variables more strictly for the comparison analyses, propensity score weighting was conducted with the use of a multinomial logistic regression model. We evaluated the clinical signatures of mucinous and poorly differentiated subtypes with regard to postoperative survival, recurrence, and chemosensitivity.
Of 5489 patients, 136 (2.5%) and 155 (2.8%) were pathologically diagnosed with poorly differentiated and mucinous subtypes. The poorly differentiated subtypes were associated with a poorer prognosis than the "others" group (HR, 1.69; 95% CI, 1.00-2.87; p = 0.051), particularly in the patient subgroup of adjuvant chemotherapy (HR, 2.16). Although the mucinous subtype had a marginal prognostic impact among patients with stage I to III colorectal cancer (HR, 1.33; 95% CI, 0.90-1.96), it was found to be an independent prognostic factor in the subpopulation of patients with stage II disease, being associated with a higher prevalence of peritoneal recurrence.
The treatment regimens of postoperative chemotherapy are now somewhat outdated.
Both mucinous and poorly differentiated subtypes have distinct clinical characteristics. Patients with the mucinous subtype require special attention during follow-up, even for stage II disease, because of the risk of peritoneal or local recurrence. See Video Abstract at http://links.lww.com/DCR/A531.
尽管结直肠癌包含几种组织学亚型，但组织学亚型对疾病进展和治疗反应的影响仍存在争议。
我们旨在通过对来自多机构 III 期试验的前瞻性收集数据进行倾向评分加权分析，评估结直肠癌中黏液型和低分化组织学亚型的预后相关性。
对 3 项 III 期试验的汇总数据库进行独立患者数据分析。
该研究数据来自于日本癌症综合治疗网络 7、15 和 33 这 3 项多中心前瞻性临床试验的综合数据库。
可切除结直肠癌患者接受单纯手术或术后辅助化疗。
为了更严格地平衡比较分析中的基本变量，使用多项逻辑回归模型进行倾向评分加权。我们评估了黏液型和低分化亚型的临床特征与术后生存、复发和化疗敏感性的关系。
在 5489 例患者中，有 136 例（2.5%）和 155 例（2.8%）病理诊断为低分化型和黏液型。低分化型与“其他”组相比预后较差（HR，1.69；95%CI，1.00-2.87；p=0.051），尤其是在辅助化疗亚组患者中（HR，2.16）。尽管黏液型在 I 期至 III 期结直肠癌患者中具有边缘预后影响（HR，1.33；95%CI，0.90-1.96），但在 II 期疾病患者亚群中，它是一个独立的预后因素，与腹膜复发的更高发生率相关。
术后化疗的治疗方案现在已经有些过时。
黏液型和低分化型都具有不同的临床特征。对于 II 期疾病患者，由于存在腹膜或局部复发的风险，黏液型患者需要在随访期间特别注意。详见视频摘要，网址：http://links.lww.com/DCR/A531。
