Huang Yong, Wei Wei, Wang Zhenguang, Liang Tao, Tian Shuyun, Fu Guangshun
Department of General Surgery, Jiangdu People' s Hospital Affiliated to Yangzhou University Medical School, Yangzhou, China.
Front Oncol. 2021 Mar 8;11:649313. doi: 10.3389/fonc.2021.649313. eCollection 2021.
The prognostic significance of ypN0 rectal cancer with comparison to pN0 disease still remains poorly defined. This study aimed to compare the prognosis of ypN0 and pN0 rectal cancer. Eligible patients were identified from the SEER18 registries research database (the latest data up to date was on April 15, 2019). Propensity score (PS) matching was usually performed to reduce the imbalance and potential confounding that were introduced by inherent differences between the groups. The cause-specific survival (CSS) was analyzed to evaluate the prognostic prediction of ypN0 and pN0 groups using the Kaplan-Meier method with the log-rank test. Cox proportional hazard model was also used to identify independent prognostic variables. In total, 26,832 patients diagnosed with pN0 or ypN0 rectal cancer were confirmed as the final cohort, including 7,237 (27.0%) patients with radiation and 19,595 (73.0%) patients without radiation prior to surgery. The median follow-up time was up to 81 months. After adjusting for other prognostic factors, neoadjuvant radiotherapy was not an independent prognostic variable of CSS (HR = 1.100, 95%CI = 0.957-1.265, = 0.180, using pN0 group as the reference). ypN0 rectal cancer was strongly associated with worse pathological diagnoses compared with pN0 rectal cancer, contributing to worse oncologic outcomes. However, the receipt of neoadjuvant chemoradiotherapy was not an independent prognostic factor of worse prognosis in pathological node-negative patients. Our study could give guidance to the treatment of ypN0 rectal cancer.
与pN0疾病相比，ypN0直肠癌的预后意义仍不明确。本研究旨在比较ypN0和pN0直肠癌的预后。符合条件的患者从SEER18登记研究数据库中识别（最新数据截至2019年4月15日）。通常进行倾向评分（PS）匹配以减少组间固有差异所带来的不平衡和潜在混杂因素。采用Kaplan-Meier法和对数秩检验分析特定病因生存率（CSS），以评估ypN0和pN0组的预后预测。还使用Cox比例风险模型来识别独立的预后变量。总共26,832例诊断为pN0或ypN0直肠癌的患者被确认为最终队列，其中包括7,237例（27.0%）术前接受放疗的患者和19,595例（73.0%）未接受放疗的患者。中位随访时间长达81个月。在调整其他预后因素后，新辅助放疗不是CSS的独立预后变量（HR = 1.100，95%CI = 0.957 - 1.265， = 0.180，以pN0组作为参照）。与pN0直肠癌相比，ypN0直肠癌与更差的病理诊断密切相关，导致更差的肿瘤学结局。然而，在病理淋巴结阴性的患者中，接受新辅助放化疗不是预后更差的独立预后因素。我们的研究可为ypN0直肠癌的治疗提供指导。
