腹腔镜对 III 期结肠癌结肠切除术肿瘤学结局的影响：来自 PETACC8 欧洲随机临床试验的事后多变量分析。
Impact of laparoscopy on oncological outcomes after colectomy for stage III colon cancer: A post-hoc multivariate analysis from PETACC8 European randomized clinical trial.
机构信息
Sorbonne Université, Department of Digestive and General Surgery, Saint Antoine Hospital, Paris, France.
Université de Paris, Department of General and Digestive Surgery, Georges Pompidou European Hospital, AP-HP, Paris, France.
出版信息
Dig Liver Dis. 2021 Aug;53(8):1034-1040. doi: 10.1016/j.dld.2021.05.012. Epub 2021 Jun 8.
BACKGROUND
In colon cancer (CC), surgery remains the mainstay of treatment with curative intent. Despite several clinical trials comparing open and laparoscopic approaches, data on long-term outcomes for stage III CC are lacking.
METHODS
This post-hoc analysis of the European PETACC8 randomized phase 3 trial included patients from 340 sites between December 2005 and November 2009, with long follow-up (median 7.56 years). Patients were randomly assigned to FOLFOX or FOLFOX+cetuximab after colonic resection. The surgical approach was left to the referring surgeon's discretion.
RESULTS
Among 2555 patients included, 1796 (70.29%) were operated on by open surgery and 759 (29.71%) by laparoscopy. The 5-year OS rate was better after laparoscopic resection (85.4%, 95%CI 82.5-87.7) than after open surgery (80.2%, 95%CI 78.2-82.0; p = 0.002). The 5-year DFS rate was also better after laparoscopy (p = 0.016). However, in multivariate analysis using a propensity matching, the surgical approach was not found to be an independent prognostic factor for OS or DFS. OS (p = 0.0243) and DFS (p = 0.035) were increased after laparoscopic surgery in KRAS/BRAF WT sub-group CONCLUSION: We showed that laparoscopic resection has comparable long-term outcomes to open surgery in patients with stage III CC. For those with RAS and BRAF WT CC, laparoscopic colectomy may favorably impact survival.
背景
在结肠癌（CC）中，手术仍然是有治愈意图的主要治疗方法。尽管有几项比较开放和腹腔镜方法的临床试验，但缺乏 III 期 CC 的长期结果数据。
方法
这项欧洲 PETACC8 随机 3 期临床试验的事后分析包括 2005 年 12 月至 2009 年 11 月期间来自 340 个地点的患者，随访时间较长（中位数 7.56 年）。患者在结肠切除术后随机分配接受 FOLFOX 或 FOLFOX+西妥昔单抗治疗。手术方法由转诊外科医生决定。
结果
在纳入的 2555 例患者中，1796 例（70.29%）接受了开放手术，759 例（29.71%）接受了腹腔镜手术。腹腔镜切除的 5 年 OS 率更好（85.4%，95%CI 82.5-87.7），优于开放手术（80.2%，95%CI 78.2-82.0；p=0.002）。腹腔镜组的 5 年DFS 率也更好（p=0.016）。然而，在使用倾向评分匹配的多变量分析中，手术方式不是 OS 或 DFS 的独立预后因素。OS（p=0.0243）和 DFS（p=0.035）在 KRAS/BRAF WT 亚组中，腹腔镜手术后均增加。
结论
我们表明，在 III 期 CC 患者中，腹腔镜切除与开放手术具有相当的长期结果。对于那些具有 RAS 和 BRAF WT CC 的患者，腹腔镜结肠切除术可能会有利地影响生存。
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