同步结直肠癌的临床病理特征和预后：一项回顾性研究。
Clinicopathologic characteristics and prognosis of synchronous colorectal cancer: a retrospective study.
机构信息
Department of Gastrointestinal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, 26 Yuancun Er Heng Rd, Guangzhou, Guangdong, China.
Guangdong Institute of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
出版信息
BMC Gastroenterol. 2022 Mar 13;22(1):120. doi: 10.1186/s12876-022-02153-9.
BACKGROUND
The clinical characteristics of synchronous colorectal cancer (SCRC) reported in previous studies differ significantly. Furthermore, little is known about the characteristics of early-onset synchronous colorectal cancer (EO-SCRC). The aim of this retrospective study was to identify the clinicopathological characteristics of SCRC and EO-SCRC and define their relevant prognostic factors.
METHODS
Patients who underwent surgery for SCRC and primary unifocal colorectal cancer (PCRC) between January 2007 and December 2020 were included in this study. The clinical, histological, and molecular characteristics of the patient's tumours were analysed. The primary endpoint was overall survival (OS). Univariate and multivariate Cox regression analyses were used to assess the association between clinicopathological factors and patient survival.
RESULTS
A total of 1554 patients were included in the analysis. Of these, 1132 (72.84%) had PCRC and 422 (27.16%) had SCRC. SCRC occurred more frequently in the elderly (P < 0.001) and in male patients (P = 0.002). The 5-year OS rate was 73.7% ± 2.0% for PCRC and 61.9% ± 3.9% for SCRC (P < 0.05). However, the Cox regression analysis showed that SCRC was not an independent prognostic factor for the prediction of OS. A total of 64 patients (15.17%) in the SCRC group had early-onset colorectal cancer (EOCRC), whereas 257 (22.70%) in the PCRC group had EOCRC (P = 0.001). The proportion of patients with deficient mismatch repair proteins (dMMR) in EO-SCRC subgroup was significantly higher than that in late-onset synchronous colorectal cancer (LO-SCRC) subgroup (23.44% vs. 10.34%, P = 0.006). Patients with EO-SCRC had more TNM stage IV (P < 0.001) and fewer opportunities for radical surgery (79.69% vs. 92.22%, P = 0.007) than those with early-onset primary unifocal colorectal cancer (EO-PCRC). There was no significant difference in 5-year OS between the EO-SCRC and LO-SCRC subgroups (P = 0.091) and between the EO-SCRC and EO-PCRC subgroups (P = 0.094). Multivariate analysis revealed that EOCRC was an independent good prognostic parameter for colorectal cancer (CRC) and SCRC.
CONCLUSION
For patients with operative treatment, EO-SCRC is different from LO-SCRC and EO-PCRC. Patients with SCRC show a poorer survival rate than those with PCRC. However, SCRC is not an independent prognostic factor for CRC, whereas EOCRC is a good prognostic factor for CRC and SCRC.
背景
先前的研究报告显示，结直肠癌（CRC）的临床特征差异显著。此外，关于早发性结直肠癌（EO-SCRC）的特征知之甚少。本回顾性研究旨在确定 SCRC 和 EO-SCRC 的临床病理特征，并定义其相关的预后因素。
方法
纳入 2007 年 1 月至 2020 年 12 月期间因 SCRC 和原发性单发结直肠癌（PCRC）接受手术的患者。分析患者肿瘤的临床、组织学和分子特征。主要终点是总生存期（OS）。使用单因素和多因素 Cox 回归分析评估临床病理因素与患者生存之间的关系。
结果
共纳入 1554 例患者，其中 1132 例（72.84%）为 PCRC，422 例（27.16%）为 SCRC。SCRC 更常见于老年人（P<0.001）和男性患者（P=0.002）。PCR 的 5 年 OS 率为 73.7%±2.0%，SCRC 为 61.9%±3.9%（P<0.05）。然而，Cox 回归分析显示 SCRC 不是预测 OS 的独立预后因素。SCRC 组共有 64 例（15.17%）为早发性结直肠癌（EOCRC），而 PCRC 组有 257 例（22.70%）为 EOCRC（P=0.001）。EO-SCRC 亚组中缺乏错配修复蛋白（dMMR）的患者比例明显高于迟发性同步结直肠癌（LO-SCRC）亚组（23.44% vs. 10.34%，P=0.006）。EO-SCRC 患者的 TNM 分期更晚期 IV 期（P<0.001），根治性手术机会更少（79.69% vs. 92.22%，P=0.007），而早发性原发性单发结直肠癌（EO-PCRC）患者更多。EO-SCRC 亚组与 LO-SCRC 亚组（P=0.091）和 EO-SCRC 亚组与 EO-PCRC 亚组（P=0.094）之间 5 年 OS 无显著差异。多因素分析显示 EOCRC 是 CRC 和 SCRC 的独立预后良好因素。
结论
对于接受手术治疗的患者，EO-SCRC 与 LO-SCRC 和 EO-PCRC 不同。SCRC 患者的生存率低于 PCRC 患者。然而，SCRC 不是 CRC 的独立预后因素，而 EOCRC 是 CRC 和 SCRC 的良好预后因素。
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