Mukkamalla Shiva Kumar R, Somasundar Ponnandai, Rathore Bharti
Hematology and Oncology, Ted and Margaret Jorgensen Cancer Center/Presbyterian Healthcare Services, Rio Rancho, USA.
Surgical Oncology, Roger Williams Medical Center, Providence, USA.
Cureus. 2020 Nov 11;12(11):e11444. doi: 10.7759/cureus.11444.
Background Locally advanced primary tumors have been associated with poor overall survival (OS) in non-metastatic colon cancer. However, their impact on metastatic colon cancer (mCC) is not fully defined. The association between primary tumor location and prognosis in mCC is also evolving. Methods Using National Cancer Data Base, we identified a cohort of 25,377 patients diagnosed with mCC from 2004-2009. Chi-square test was used for descriptive analyses, while all potential prognostic factors were evaluated using Kaplan-Meier survival estimates and Cox proportional hazards regression modeling. Results The five-year OS for the entire study cohort was 12.3%. Factors associated with significant survival impact in multivariate analysis included age, gender, race, comorbidity index, academic level of treating institution, insurance status, income, year of diagnosis, primary tumor site, histologic differentiation, pathologic tumor stage (pT), pathologic nodal stage (pN), and modality of chemotherapy. pT1 lesions demonstrated poor prognosis in stage IV colon cancers, not statistically different when compared to survival outcomes observed in cases with pT4 lesions. Regional nodal involvement demonstrated poor OS in full cohort analysis and subgroup analysis independent of primary tumor location. Both right-sided and transverse colon tumors had similarly worse OS compared to left-sided tumors (right-sided: HR: 1.21, 95% CI: 1.17-1.25; transverse: HR: 1.21, 95% CI: 1.15-1.27). Conclusions T1 lesions arising from right-side or transverse colon portend a poor prognosis in mCC, while regional lymph node involvement by itself is an independent poor prognostic factor. Right-sided tumors are associated with poor outcomes than left-sided tumors, suggesting the role of underlying molecular or biologic variants.
局部进展期原发性肿瘤与非转移性结肠癌的总生存期（OS）较差有关。然而，它们对转移性结肠癌（mCC）的影响尚未完全明确。原发性肿瘤位置与mCC预后之间的关联也在不断演变。方法：利用国家癌症数据库，我们确定了一组2004年至2009年被诊断为mCC的25377例患者。采用卡方检验进行描述性分析，同时使用Kaplan-Meier生存估计和Cox比例风险回归模型评估所有潜在的预后因素。结果：整个研究队列的五年总生存期为12.3%。多变量分析中与显著生存影响相关的因素包括年龄、性别、种族、合并症指数、治疗机构的学术水平、保险状况、收入、诊断年份、原发性肿瘤部位、组织学分化、病理肿瘤分期（pT）、病理淋巴结分期（pN）和化疗方式。pT1病变在IV期结肠癌中预后较差，与pT4病变患者的生存结果相比无统计学差异。在全队列分析和亚组分析中，无论原发性肿瘤位置如何，区域淋巴结受累均显示总生存期较差。与左侧肿瘤相比，右侧和横结肠癌的总生存期同样较差（右侧：HR：1.21，95%CI：1.17-1.25；横结肠：HR：1.21，95%CI：1.15-1.27）。结论：右侧或横结肠的T1病变预示着mCC的预后较差，而区域淋巴结受累本身就是一个独立的不良预后因素。右侧肿瘤的预后比左侧肿瘤差，提示潜在分子或生物学变异的作用。
