Discipline of Surgery, Faculty of Medicine and Health, The University of Sydney, Sydney 2145, Australia.
Division of Colorectal Surgery, Department of Surgery, Westmead Hospital, Westmead 2145, Australia.
Curr Oncol. 2022 Feb 23;29(3):1370-1389. doi: 10.3390/curroncol29030116.
There is not a clear consensus on which pathological features and biomarkers are important in guiding prognosis and adjuvant therapy in colon cancer. The Pathology in Colon Cancer, Prognosis and Uptake of Adjuvant Therapy (PiCC UP) Australia and New Zealand questionnaire was distributed to colorectal surgeons, medical oncologists and pathologists after institutional board approval. The aim of this study was to understand current specialist attitudes towards pathological features in the prognostication of colon cancer and adjuvant therapy in stage II disease. A 5-scale Likert score was used to assess attitudes towards 23 pathological features for prognosis and 18 features for adjuvant therapy. Data were analysed using a rating scale and graded response model in item response theory (IRT) on STATA (Stata MP, version 15; StataCorp LP). One hundred and sixty-four specialists (45 oncologists, 86 surgeons and 33 pathologists) participated. Based on IRT modelling, the most important pathological features for prognosis in colon cancer were distant metastases, lymph node metastases and liver metastases. Other features seen as important were tumour rupture, involved margin, radial margin, CRM, lymphovascular invasion and grade of differentiation. Size of tumour, location, lymph node ratio and EGFR status were considered less important. The most important features in decision making for adjuvant therapy in stage II colon cancer were tumour rupture, lymphovascular invasion and microsatellite instability. BRAF status, size of tumour, location, tumour budding and tumour infiltrating lymphocytes were factored as lesser importance. Biomarkers such as CDX2, EGFR, KRAS and BRAF status present areas for further research to improve precision oncology. This study provides the most current status on the importance of pathological features in prognostication and recommendations for adjuvant therapy in Australia and New Zealand. Results of this nationwide study may be useful to help in guiding prognosis and adjuvant treatment in colon cancer.
对于哪些病理特征和生物标志物对于指导结肠癌的预后和辅助治疗很重要，目前尚未达成明确共识。在机构委员会批准后，向结直肠外科医生、肿瘤内科医生和病理学家分发了澳大利亚和新西兰的结肠癌病理、预后和辅助治疗（PiCC UP）问卷。本研究的目的是了解目前专家对结肠癌预后和辅助治疗中病理特征的态度，以及在 II 期疾病中的辅助治疗。采用 5 级李克特评分评估 23 种预后和 18 种辅助治疗的病理特征。使用 STATA（Stata MP，版本 15；StataCorp LP）中的评分量表和项目反应理论（IRT）的等级反应模型对数据进行分析。共有 164 名专家（45 名肿瘤学家、86 名外科医生和 33 名病理学家）参与了这项研究。根据 IRT 模型，结肠癌预后最重要的病理特征是远处转移、淋巴结转移和肝转移。其他被认为重要的特征包括肿瘤破裂、受累边缘、径向边缘、CRM、血管淋巴管侵犯和分化程度。肿瘤大小、位置、淋巴结比率和 EGFR 状态被认为不太重要。在 II 期结肠癌辅助治疗决策中最重要的特征是肿瘤破裂、血管淋巴管侵犯和微卫星不稳定性。BRAF 状态、肿瘤大小、位置、肿瘤芽生和肿瘤浸润淋巴细胞被认为是次要重要因素。CDX2、EGFR、KRAS 和 BRAF 状态等生物标志物是进一步研究的领域，以提高肿瘤精准治疗的水平。本研究提供了澳大利亚和新西兰在预后和辅助治疗中病理特征重要性的最新现状。这项全国性研究的结果可能有助于指导结肠癌的预后和辅助治疗。
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