Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, 420 Fuma Rd, Jin'an District, Fuzhou, 350014, China.
Sci Rep. 2021 Jun 3;11(1):11782. doi: 10.1038/s41598-021-91172-9.
The clinical efficacy of adjuvant radiotherapy in sigmoid colon cancer remains questioned. To evaluate the clinical efficacy of adjuvant external beam radiotherapy (EBRT) for patients with pathologic stage T4b sigmoid colon cancer. Patients with stage pT4b sigmoid colon cancer receiving adjuvant EBRT or not followed by surgery between 2004 and 2016 were extracted from the Surveillance, Epidemiology, and End Results database. Analysis of overall survival (OS) was performed using Kaplan-Meier curves and prognostic factors were identified using Cox proportional hazards regression models with 95% confidence intervals within the entire cohort. A risk-stratification system was then developed based on the β regression coefficient. Among 2073 patients, 284 (13.7%) underwent adjuvant EBRT. The median OS in the group receiving adjuvant EBRT was significantly longer than that in the non-radiotherapy group (p < 0.001). Age, serum carcinoembryonic antigen (CEA) level, perineural invasion, lymph node dissection (LND) number, and adjuvant EBRT were independent factors associated with OS. A risk-stratification system was generated, which showed that low-risk patients had a higher 5-year survival rate than high-risk patients (75.6% vs. 42.3%, p < 0.001). Adjuvant EBRT significantly prolonged the 5-year survival rate of high-risk patients (62.6% vs. 38.3%, p = 0.009) but showed no survival benefit among low-risk patients (87.7% vs. 73.2%, p = 0.100). Our risk-stratification model comprising age, serum CEA, perineural invasion, and LND number predicted the outcomes of patients with stage pT4b sigmoid colon cancer based on which subgroup of high-risk patients should receive adjuvant EBRT.
辅助放疗在乙状结肠癌中的临床疗效仍存在争议。本研究旨在评估辅助外照射放疗（EBRT）对病理分期 T4b 乙状结肠癌患者的临床疗效。从 Surveillance, Epidemiology, and End Results 数据库中提取了 2004 年至 2016 年间接受辅助 EBRT 或未接受 EBRT 辅助治疗后接受手术的 T4b 乙状结肠癌患者。采用 Kaplan-Meier 曲线进行总生存（OS）分析，并采用 Cox 比例风险回归模型识别预后因素，置信区间为整个队列。然后根据β回归系数开发了一种风险分层系统。在 2073 例患者中，284 例（13.7%）接受了辅助 EBRT。接受辅助 EBRT 组的中位 OS 明显长于未接受放疗组（p<0.001）。年龄、血清癌胚抗原（CEA）水平、神经周围侵犯、淋巴结清扫（LND）数量和辅助 EBRT 是与 OS 相关的独立因素。建立了一种风险分层系统，该系统显示低危患者的 5 年生存率高于高危患者（75.6% vs. 42.3%，p<0.001）。辅助 EBRT 显著提高了高危患者的 5 年生存率（62.6% vs. 38.3%，p=0.009），但在低危患者中没有生存获益（87.7% vs. 73.2%，p=0.100）。我们的风险分层模型包括年龄、血清 CEA、神经周围侵犯和 LND 数量，可根据该模型预测 T4b 乙状结肠癌患者的结局，从而确定高危患者亚组是否应接受辅助 EBRT。
