Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China.
Department of Medical Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Affiliated Cancer Hospital of Nanjing Medical University, Nanjing China.
Cancer Epidemiol. 2019 Oct;62:101565. doi: 10.1016/j.canep.2019.07.004. Epub 2019 Jul 16.
Poor survival among colorectal cancer (CRC) patients has been widely associated with clinico-epidemiological features and treatment regimen. In Jiangsu (China), however, it is not known which one of the prognostic factors explains the survival disparities among patients with CRC. This prospective study using 1078 patients (stages I-IV) that underwent surgery at Jiangsu Hospital, explored the relevant factors affecting the prognoses of right-side colon cancer (RCC), left-side colon cancer (LCC) and rectal cancer (ReC) patients. Of these cases, 234 (21.7%), 241 (22.4%) and 603 (55.9%) were found to have RCC, LCC and ReC respectively. Compared to LCC, RCC exhibited a greater proportion of older patients, poorly differentiated carcinomas, higher T-stage and higher TNM-stage. The overall survival (OS) for RCC was 60 vs.78 or 77 months for LCC or ReC respectively (P = 0.030). There were no significant differences in OS between LCC and ReC across the subgroups (P = 0.633). In multivariate analysis, RCC patients had age (>60 vs. ≤60 years, HR = 1.529, P = 0.019), N-stage (N1 vs. N0, HR = 4.056, P = 0.012) and M-stage (M1 vs. M0, HR = 3.442, P < 0.0001) as independent prognostic factors, whereas smoking status was found to be a predictor of mortality (smoker vs. nonsmoker, HR = 2.343, P = 0.017) for LCC. In addition, age (>60 vs. ≤60 years, HR = 2.199, P < 0.0001), alcohol consumption (drinker vs. nondrinker, HR = 0.510, P = 0.034), tumor grade (Poor vs. well/moderate, HR = 2.759, P = 0.031) and T-stage (T3-4 vs. T1-2, HR = 1.742, P < 0.0001) were found to be predictors of mortality for ReC. There were significant pairwise interactions across subgroups. Furthermore, significant differences were observed for LCC vs. RCC (OS, HR = 0.783, P = 0.039), but no statistically significant differences for ReC vs. RCC (P = 0.149) and LCC vs. ReC (P = 0.355). Nevertheless, significant differences remained between ReC vs. RCC for male (HR = 0.591, P = 0.009), drinker (HR = 0.396, P = 0.005), rural resident (HR = 0.437,P = 0.022), tumor grade (well/moderate, HR = 0.475, P = 0.022), T-stage (T1-2, HR = 0.362, P = 0.001), N-stage (N0, HR = 0.604, P = 0.011), M-stage(M0, HR = 0.401, P = 0.006) and TNM-stage (I-II, HR = 0.567, P = 0.005). Statistically significant differences were observed for LCC vs. RCC for gender (female, HR = 0.495, P = 0.003) and T-stage (T1-2, HR = 0.417, P = 0.010) as well as for LCC vs. ReC in patients with smoking habits (HR = 1.951, P = 0.002) and M-stage (M0, HR = 2.291, P = 0.003). These findings suggest that the variations in CRC post-surgical survival in China may be primarily explained with the clinicopathologic features and epidemiological characteristic of the patients. Patients with RCC had significantly worse OS compared to both LCC and ReC in several subgroups.
在中国江苏,结直肠癌(CRC)患者的生存率较差与临床流行病学特征和治疗方案广泛相关。然而,目前尚不清楚预后因素中的哪一个可以解释 CRC 患者之间的生存差异。本研究使用了江苏医院接受手术的 1078 名患者(I-IV 期),探讨了右半结肠癌(RCC)、左半结肠癌(LCC)和直肠癌(ReC)患者预后的相关因素。其中 234 例(21.7%)、241 例(22.4%)和 603 例(55.9%)分别为 RCC、LCC 和 ReC。与 LCC 相比,RCC 患者中老年人、低分化癌、更高的 T 分期和更高的 TNM 分期的比例更大。RCC 的总体生存率(OS)为 60 个月,而 LCC 和 ReC 分别为 78 或 77 个月(P=0.030)。在亚组中,LCC 和 ReC 之间的 OS 无显著差异(P=0.633)。多变量分析显示,RCC 患者的年龄(>60 岁与≤60 岁,HR=1.529,P=0.019)、N 分期(N1 与 N0,HR=4.056,P=0.012)和 M 分期(M1 与 M0,HR=3.442,P<0.0001)是独立的预后因素,而吸烟状况是 LCC 患者死亡的预测因素(吸烟者与非吸烟者,HR=2.343,P=0.017)。此外,年龄(>60 岁与≤60 岁,HR=2.199,P<0.0001)、饮酒(饮酒者与非饮酒者,HR=0.510,P=0.034)、肿瘤分级(差与良好/中等,HR=2.759,P=0.031)和 T 分期(T3-4 与 T1-2,HR=1.742,P<0.0001)是 ReC 患者死亡的预测因素。亚组之间存在显著的交互作用。此外,LCC 与 RCC 之间的 OS 存在显著差异(HR=0.783,P=0.039),但 ReC 与 RCC 之间(P=0.149)和 LCC 与 ReC 之间(P=0.355)无统计学差异。然而,在男性(HR=0.591,P=0.009)、饮酒者(HR=0.396,P=0.005)、农村居民(HR=0.437,P=0.022)、肿瘤分级(良好/中等,HR=0.475,P=0.022)、T 分期(T1-2,HR=0.362,P=0.001)、N 分期(N0,HR=0.604,P=0.011)、M 分期(M0,HR=0.401,P=0.006)和 TNM 分期(I-II,HR=0.567,P=0.005)方面,ReC 与 RCC 之间仍存在显著差异。LCC 与 RCC 之间的 OS 存在显著差异(女性,HR=0.495,P=0.003)和 T 分期(T1-2,HR=0.417,P=0.010),LCC 与 ReC 之间的 OS 也存在显著差异(吸烟习惯,HR=1.951,P=0.002)和 M 分期(M0,HR=2.291,P=0.003)。这些发现表明,中国 CRC 术后生存的差异可能主要与患者的临床病理特征和流行病学特征有关。在几个亚组中,RCC 患者的 OS 明显比 LCC 和 ReC 差。