Wei Zhewen, Mao Rui, Zhang Yefan, Bi Xinyu, Zhou Jianguo, Li Zhiyu, Huang Zhen, Chen Xiao, Zhao Jianjun, Zhao Hong, Cai Jianqiang
Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Ann Transl Med. 2021 Feb;9(3):250. doi: 10.21037/atm-20-4286.
Primary colorectal sarcoma is an extremely rare malignancy that is associated with poor patient outcomes. The aim of this study was to identify the prognostic factors of primary colorectal sarcoma and evaluate the clinical outcomes associated with these prognostic factors.
Between January 1, 2000 and December 31, 2016, the clinical data of 315 patients with primary colorectal sarcoma were obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Cancer-specific survival (CSS) was analyzed by the Kaplan-Meier method and by log-rank test. The prognostic factors were identified by univariate and multivariate Cox regression analysis and hazard ratio (HR) and 95% confidence interval (CI) of covariates were also estimated. The optimal cutoff value for NLN count at dissection was identified using X-tile software and validated by univariate Cox regression analysis.
Of the 315 patients with primary colorectal sarcoma identified, 88.6% received surgery. The median follow-up time was 34 months with an interquartile range (IQR) of 9-79 months. The 5-year rate of CSS was 76.73% and 27.8% for the surgery group and the non-surgery group, respectively (P<0.0001). Univariate and multivariate Cox regression analysis performed on the data of nonmetastatic patients demonstrated that sex, race, radiotherapy, and chemotherapy had no effect on patient CSS, with age, tumor site, tumor grade, and NLN dissection being independent prognostic factors. A significant correlation was found between advanced age (>80 years old) and poor CSS (HR 1.964; 95% CI: 1.005-3.839; P=0.048). There were also significant correlations between colonic tumors and poor CSS (HR 2.903; 95% CI: 1.348-6.250; P=0.006) and grade IV tumors and poor CSS (HR 3.431; 95% CI: 1.725-6.823; P<0.001), while NLN dissection was associated with improved CSS (HR 0.946; 95% CI: 0.911-0.983; P=0.004). X-tile software analysis was used to determine that the optimal cutoff value for NLN count was 13. Patients who received NLN dissection with a cutoff value of 13 or more displayed better CSS than those who did not (P=0.016).
Primary colorectal sarcoma patients can benefit significantly from primary tumor surgery. Age, tumor site, grade and NLN dissection are independent prognostic factors for CSS in nonmetastatic patients. Importantly, nonmetastatic patients treated with NLN dissection with an NLN count of 13 or more have significantly better CSS.
原发性结直肠肉瘤是一种极其罕见的恶性肿瘤，与患者的不良预后相关。本研究的目的是确定原发性结直肠肉瘤的预后因素，并评估与这些预后因素相关的临床结局。
在2000年1月1日至2016年12月31日期间，从监测、流行病学和最终结果（SEER）数据库中获取了315例原发性结直肠肉瘤患者的临床数据。采用Kaplan-Meier法和对数秩检验分析癌症特异性生存率（CSS）。通过单因素和多因素Cox回归分析确定预后因素，并估计协变量的风险比（HR）和95%置信区间（CI）。使用X-tile软件确定解剖时NLN计数的最佳临界值，并通过单因素Cox回归分析进行验证。
在确定的315例原发性结直肠肉瘤患者中，88.6%接受了手术。中位随访时间为34个月，四分位间距（IQR）为9 - 79个月。手术组和非手术组的5年CSS率分别为76.73%和27.8%（P<0.0001）。对非转移性患者的数据进行单因素和多因素Cox回归分析表明，性别、种族、放疗和化疗对患者CSS无影响，年龄、肿瘤部位、肿瘤分级和NLN解剖是独立的预后因素。发现高龄（>80岁）与不良CSS之间存在显著相关性（HR 1.964；95% CI：1.005 - 3.839；P = 0.048）。结肠肿瘤与不良CSS（HR 2.903；95% CI：1.348 - 6.250；P = 0.006）以及IV级肿瘤与不良CSS（HR 3.431；95% CI：1.725 - 6.823；P<0.001）之间也存在显著相关性，而NLN解剖与CSS改善相关（HR 0.946；95% CI：0.911 - 0.983；P = 0.004）。X-tile软件分析确定NLN计数的最佳临界值为13。接受NLN解剖且临界值为13或更高的患者显示出比未接受者更好的CSS（P = 0.016）。
原发性结直肠肉瘤患者可从原发性肿瘤手术中显著获益。年龄、肿瘤部位、分级和NLN解剖是非转移性患者CSS的独立预后因素。重要的是，接受NLN解剖且NLN计数为13或更多的非转移性患者具有显著更好的CSS。
