Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, China; Shandong Provincial Engineering and Technological Research Center for Liver Diseases Prevention and Control, Jinan, 250021, China.
Department of Cardiology, Central Hospital of Zibo, Zibo, 255036, China.
Int J Surg. 2018 Aug;56:188-194. doi: 10.1016/j.ijsu.2018.06.029. Epub 2018 Jun 21.
The goal was to determine whether tumor deposits (TDs) had effects on the overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS) and responses to chemotherapy in advanced colorectal cancer (CRC) patients with different lymph node (N) stages.
The retrospective cohort study recruited 1455 stage III CRC patients diagnosed at a single institution between January 2010 and July 2016. Patients were divided into TDs negative and positive groups. Based on whether they accepted chemotherapy, patients were further divided into chemotherapy and non-chemotherapy groups. Kaplan-Meier methods, univariate and multivariate analyses, and subset analyses based on the N stage were performed to compare the OS, CSS and DFS between different groups.
Multivariate Cox analyses showed that TDs were independent prognostic markers for the OS (adjusted HR = 1.929, 95% CI: 1.339-2.777), CSS (adjusted HR = 1.789, 95% CI: 1.165-2.748) and DFS (adjusted HR = 2.179, 95% CI: 1.612-2.944) in all N stages combined. In addition, subset analyses based on the N stage further demonstrated that TDs were independent risk factors for the OS (P = 0.012), CSS (P = 0.010) and DFS (P < 0.001) in patients with the N1a, 1 b stages, and for the OS (P = 0.023) and DFS (P < 0.001) in patients with the N2a, 2 b stages. Furthermore, the OS, CSS and DFS in the TDs negative group could be extended significantly after the administration of chemotherapy, whereas patients with positive TDs lost the DFS benefit from chemotherapy.
Stage III CRC patients with positive TDs had a poor prognosis, and they did not display a DFS benefit from chemotherapy. TDs had adverse effects on the OS and DFS in patients with the N1a, 1 b and N2a, 2 b stages, providing evidence for the feasibility of the new TNM category method.
本研究旨在探讨肿瘤转移灶（TDs）对不同淋巴结（N）分期的晚期结直肠癌（CRC）患者的总生存（OS）、癌症特异性生存（CSS）、无病生存（DFS）和化疗反应的影响。
本回顾性队列研究纳入了 2010 年 1 月至 2016 年 7 月期间在一家医疗机构诊断为 III 期 CRC 的 1455 例患者。将患者分为 TDs 阴性和阳性组。根据是否接受化疗，患者进一步分为化疗和非化疗组。采用 Kaplan-Meier 方法、单因素和多因素分析以及基于 N 分期的亚组分析，比较不同组间的 OS、CSS 和 DFS。
多因素 Cox 分析显示，TDs 是所有 N 分期患者 OS（调整后的 HR=1.929，95%CI：1.339-2.777）、CSS（调整后的 HR=1.789，95%CI：1.165-2.748）和 DFS（调整后的 HR=2.179，95%CI：1.612-2.944）的独立预后因素。此外，基于 N 分期的亚组分析进一步表明，TDs 是 N1a、1b 期患者 OS（P=0.012）、CSS（P=0.010）和 DFS（P<0.001）以及 N2a、2b 期患者 OS（P=0.023）和 DFS（P<0.001）的独立危险因素。此外，TDs 阴性组患者接受化疗后 OS、CSS 和 DFS 显著延长，而 TDs 阳性组患者失去了化疗的 DFS 获益。
TDs 阳性的 III 期 CRC 患者预后不良，且无化疗 DFS 获益。TDs 对 N1a、1b 和 N2a、2b 期患者的 OS 和 DFS 有不良影响，为新的 TNM 分期方法的可行性提供了证据。
