现行的治疗和监测方式对于晚期 III 期结肠癌并不充分：一项多中心队列分析的结果。
Current treatment and surveillance modalities are not sufficient for advanced stage III colon cancer: Result from a multicenter cohort analysis.
机构信息
Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangdong Institute of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
出版信息
Cancer Med. 2021 Dec;10(24):8924-8933. doi: 10.1002/cam4.4417. Epub 2021 Nov 16.
OBJECTIVE
We conducted this multicenter cohort study to evaluate the current tumor-node-metastasis staging system and treatment modality by analyzing the survival outcomes of patient groups with stage III and IV colon cancer.
PATIENTS AND METHODS
Stage III and IV colon cancer patients from the Surveillance, Epidemiology, and End Results (SEER) database (SEER cohort) and prospectively maintained Sun Yat-sen University (SYSU) cohort were included in this study. Kaplan-Meier method was used to estimate the cumulative rate of overall survival (OS) between patient groups, and the inverse probability weighting method was used to calculated age and sex-adjusted survival curves. The Cox regression model was used to identify the risk factors for OS.
RESULTS
A total of 17,911 and 1135 stage III-IV cases were included in the SEER and SYSU cohorts, respectively. Among them, 1448 and 124 resectable stage IV cases underwent curative-intent treatment in the SEER and SYSU cohorts, respectively. The T4N2b group showed a significantly worse survival outcome compared with the M1a subset receiving curative-intent treatment (HR, 1.46; p < 0.001). This finding was validated in the SYSU cohort, in which the T4N2 group had a worse outcome than that of the M1 group receiving curative-intent treatment (HR, 2.44; p < 0.001). These findings were confirmed in the adjusted survival analysis. In the multivariate analysis, the right-side tumor, poor-undifferentiated tumor, and age over 60 years were identified as independent risk factors for T4N2b patients. Based on this multivariate model, the high-risk T4N2b subgroup had a worse survival outcome compared with resectable M1b patients (HR, 1.24; p = 0.03).
CONCLUSION
By comparing stage III with stage IV colon cancer patients, we identified a subgroup of stage III patients at a higher risk of death than more advanced stages, implying that current cancer care modalities are not sufficient for these high-risk substages.
目的
通过分析 III 期和 IV 期结肠癌患者的生存结果，我们对当前的肿瘤-淋巴结-转移分期系统和治疗方式进行了多中心队列研究。
患者和方法
本研究纳入了来自监测、流行病学和最终结果（SEER）数据库（SEER 队列）和中山大学（SYSU）前瞻性维护队列的 III 期和 IV 期结肠癌患者。Kaplan-Meier 法用于估计两组患者的总生存（OS）累积率，逆概率加权法用于计算年龄和性别调整后的生存曲线。Cox 回归模型用于识别 OS 的危险因素。
结果
SEER 队列和 SYSU 队列分别纳入了 17911 例和 1135 例 III-IV 期病例。其中，SEER 队列中有 1448 例和 SYSU 队列中有 124 例可切除的 IV 期病例接受了根治性治疗。与接受根治性治疗的 M1a 亚组相比，T4N2b 组的生存结果明显较差（HR，1.46；p<0.001）。这一发现在 SYSU 队列中得到了验证，其中 T4N2 组的生存结果比接受根治性治疗的 M1 组更差（HR，2.44；p<0.001）。这些发现在调整后的生存分析中得到了验证。在多变量分析中，右侧肿瘤、低分化肿瘤和年龄超过 60 岁被确定为 T4N2b 患者的独立危险因素。基于这个多变量模型，高危 T4N2b 亚组的生存结果比可切除的 M1b 患者更差（HR，1.24；p=0.03）。
结论
通过比较 III 期和 IV 期结肠癌患者，我们发现了一个 III 期患者亚组的死亡风险高于更晚期的患者，这表明当前的癌症治疗方式对这些高危亚组不够充分。
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