Liu Qi, Luo Dakui, An Hongyin, Zhang Sheng, Cai Sanjun, Li Qingguo, Li Xinxiang
Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
J Cancer. 2019 Jan 29;10(5):1209-1215. doi: 10.7150/jca.28917. eCollection 2019.
: The effect of adjuvant chemotherapy on stage II colon cancer remains constantly controversial. Recently, however, several studies have reported the definite survival benefit of adjuvant chemotherapy (ACT) in T4 disease (stage IIB and IIC) among stage II colon cancer patients. The following study investigates the efficacy of ACT in patients with poorly differentiated stage IIA colon cancer. : The first cohort of eligible patients (N=38384) diagnosed with stage IIA colon cancer was selected from the Surveillance, Epidemiology, and End Results database (SEER) between January 1, 2004, and December 31, 2010. Cox proportional hazards regression analyses and Kaplan-Meier curves were used to evaluate the survival benefit following ACT. Our findings were also evaluated in Fudan University Shanghai Cancer Center (FUSCC) cohort form FUSCC database. : In SEER cohort, poorly differentiated or undifferentiated tumor grade was associated with 21.5% increased cancer-specific mortality in patients who did not receive ACT (HR=1.215, 1.004-1.469, P=0.045, using poorly differentiated or undifferentiated ACT as a reference). In FUSCC cohort, poorly differentiated or undifferentiated tumor grade was also associated with increased DFS in patients who received ACT (HR = 0.160, 95% CI = 0.017-1.505, P=0.109, using poorly differentiated or undifferentiated, non-ACT as a reference). In addition, patients with poorly differentiated or undifferentiated tumor who did not receive ACT had a higher risk of distant metastasis and recurrence compared to patients who received ACT (log-rank P=0.027 and 0.119, respectively). : ACT decreased the recurrence rate and distant metastasis rate thus improving prognosis for poorly differentiated or undifferentiated stage IIA colon cancer.
辅助化疗对II期结肠癌的疗效一直存在争议。然而，最近有几项研究报告了辅助化疗（ACT）在II期结肠癌患者的T4期疾病（IIB期和IIC期）中具有明确的生存获益。以下研究调查了ACT在低分化IIA期结肠癌患者中的疗效。：从监测、流行病学和最终结果数据库（SEER）中选取了2004年1月1日至2010年12月31日期间诊断为IIA期结肠癌的首批符合条件的患者（N = 38384）。采用Cox比例风险回归分析和Kaplan-Meier曲线来评估ACT后的生存获益。我们的研究结果也在复旦大学附属肿瘤医院（FUSCC）数据库的FUSCC队列中进行了评估。：在SEER队列中，未接受ACT的患者中，低分化或未分化肿瘤分级与癌症特异性死亡率增加21.5%相关（HR = 1.215，1.004 - 1.469，P = 0.045，以低分化或未分化ACT作为对照）。在FUSCC队列中，低分化或未分化肿瘤分级在接受ACT的患者中也与DFS增加相关（HR = 0.160，95%CI = 0.017 - 1.505，P = 0.109，以低分化或未分化、未接受ACT作为对照）。此外，与接受ACT的患者相比，未接受ACT的低分化或未分化肿瘤患者发生远处转移和复发的风险更高（对数秩检验P分别为0.027和0.119）。：ACT降低了复发率和远处转移率，从而改善了低分化或未分化IIA期结肠癌的预后。
