Kim Chan Wook, Kim Tae Won, Lee Jong Lyul, Park In Ja, Yoon Yong Sik, Lim Seok-Byung, Yu Chang Sik, Kim Jin Cheon
Department of Surgery University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Department of Surgical Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Clin Colorectal Cancer. 2020 Dec;19(4):e157-e163. doi: 10.1016/j.clcc.2020.03.001. Epub 2020 Mar 19.
To investigate the survival outcomes of patients with stage IIIA colon cancer. In addition, risk factors that affect the oncologic outcome of stage IIIA colon cancer patients and the role of adjuvant chemotherapy were evaluated.
Data from 326 colon cancer patients with stage IIIA who underwent surgery between January 2000 and December 2016 were retrospectively reviewed. Patients diagnosed with hereditary cancer and those who received preoperative neoadjuvant therapy were excluded.
The 5-year recurrence-free survival (RFS) rate in stage IIIA colon cancer patients who underwent curative resection was 93.9%. Of the patients with recurrence, the survival rate of those who underwent surgical resection was better than that of patients who received palliative chemotherapy or no treatment (12/13, 92.3% vs. 2/4, 50.0%), respectively; P = .052). Multivariate analysis showed that high serum carcinoembryonic antigen (s-CEA) was an independent and statistically significant prognostic factor for RFS, and ulcerative gross-type disease tended to be a poor prognostic factor. There was no difference in RFS in patients with elevated s-CEA or ulcerative gross-type disease according to receipt of adjuvant chemotherapy.
Patients with stage IIIA colon cancer had a relatively favorable survival outcome. Even in patients with relapsed disease, long-term survival could be a result if surgical resection is accomplished. High s-CEA concentration is a significant poor prognostic factor for recurrence, and ulcerative gross-type disease tends to be a poor prognostic factor. Postoperative adjuvant chemotherapy may not provide a survival benefit for stage IIIA colon cancer, even in the presence of risk factors. Because of the rarity of this patient group and the low rate of recurrence, large-scale multicenter studies are needed to find and confirm the risk group that would receive a benefit from adjuvant chemotherapy.
研究IIIA期结肠癌患者的生存结局。此外，评估影响IIIA期结肠癌患者肿瘤学结局的危险因素以及辅助化疗的作用。
回顾性分析2000年1月至2016年12月期间接受手术的326例IIIA期结肠癌患者的数据。排除诊断为遗传性癌症的患者以及接受术前新辅助治疗的患者。
接受根治性切除的IIIA期结肠癌患者的5年无复发生存（RFS）率为93.9%。在复发患者中，接受手术切除的患者的生存率优于接受姑息化疗或未接受治疗的患者（分别为12/13，92.3%对2/4，50.0%）；P = 0.052）。多因素分析显示，高血清癌胚抗原（s-CEA）是RFS的独立且具有统计学意义的预后因素，溃疡性大体类型疾病倾向于为不良预后因素。根据是否接受辅助化疗，s-CEA升高或溃疡性大体类型疾病患者的RFS无差异。
IIIA期结肠癌患者的生存结局相对良好。即使是复发患者，如果完成手术切除也可能获得长期生存。高s-CEA浓度是复发的显著不良预后因素，溃疡性大体类型疾病倾向于为不良预后因素。术后辅助化疗可能不会为IIIA期结肠癌患者带来生存获益，即使存在危险因素。由于该患者群体罕见且复发率低，需要大规模多中心研究来发现和确认能从辅助化疗中获益的风险组。
