Sorbonne Université, Assistance Publique Hôpitaux de Paris, Department of Digestive Surgery, Pitié Salpêtrière University Hospital, Paris, France.
Sorbonne Université, Assistance Publique Hôpitaux de Paris, Saint Antoine University Hospital, Department of Digestive Surgery, Paris, France.
Langenbecks Arch Surg. 2019 Sep;404(6):717-729. doi: 10.1007/s00423-019-01819-5. Epub 2019 Oct 10.
At equal TNM stage, obstructing colon cancer (OCC) is associated with worse prognosis in comparison with uncomplicated cancer. Our aim was to identify prognostic factors of overall (OS) and disease-free survival (DFS) in patients treated for OCC.
From 2000 to 2015, 2325 patients were treated for OCC in French surgical centers, members of the French National Surgical Association (AFC). Patients with palliative management were excluded. The main endpoints were OS and DFS. A multivariate analysis, using Cox proportional hazards regression model, was performed to determine independent prognostic factors.
The cohort included 2120 patients. The median of follow-up was 13.2 months. In multivariate analysis, age > 75 years, ASA score ≥ 3, ECOG score ≥ 3, right-sided colon cancer, presence of synchronous metastases, anastomotic leakage, and absence of adjuvant chemotherapy were independent OS factors. Age > 75 years, ASA score ≥ 3, right-sided colon cancer, presence of synchronous metastases, and absence of postoperative chemotherapy were independent factors of poor OS after exclusion of patients who died postoperatively. Age ≥ 75 years, ASA score ≥ 3, ECOG score ≥ 3, right-sided colon cancer, lymph node involvement, presence of vascular, lymphatic or perineural invasion, less than 12 harvested lymph nodes, and absence of adjuvant chemotherapy were independent DFS factors.
Management of OCC should take into account prognostic factors related to the patient (age, comorbidities), tumor location, and tumor stage. Adjuvant chemotherapy administration plays an important role. For patients undergoing initial defunctionning stoma, neoadjuvant chemotherapy could be an option to improve prognosis.
在相同的 TNM 分期下，相较于非复杂癌症，阻塞性结肠癌（OCC）与更差的预后相关。我们的目的是确定接受 OCC 治疗的患者的总生存（OS）和无病生存（DFS）的预后因素。
2000 年至 2015 年，法国外科协会（AFC）成员的法国外科中心对 2325 例 OCC 患者进行了治疗。排除姑息性治疗的患者。主要终点是 OS 和 DFS。使用 Cox 比例风险回归模型进行多变量分析，以确定独立的预后因素。
该队列包括 2120 例患者。中位随访时间为 13.2 个月。多变量分析显示，年龄>75 岁、ASA 评分≥3、ECOG 评分≥3、右半结肠癌、存在同步转移、吻合口漏和无辅助化疗是 OS 的独立因素。排除术后死亡患者后，年龄>75 岁、ASA 评分≥3、右半结肠癌、存在同步转移和无术后化疗是 OS 不良的独立因素。年龄≥75 岁、ASA 评分≥3、ECOG 评分≥3、右半结肠癌、淋巴结受累、存在血管、淋巴管或神经周围侵犯、少于 12 个淋巴结采集和无辅助化疗是 DFS 的独立因素。
OCC 的管理应考虑与患者（年龄、合并症）、肿瘤位置和肿瘤分期相关的预后因素。辅助化疗的应用起着重要的作用。对于接受初始去功能化造口术的患者，新辅助化疗可能是改善预后的一种选择。
