基于将淋巴管侵犯、神经周围侵犯和T4状态相结合的新型分类的II-III期结肠癌无复发生存结果
Recurrence-Free Survival Outcomes Based on Novel Classification Combining Lymphovascular Invasion, Perineural Invasion, and T4 Status in Stage II-III Colon Cancer.
作者信息
Kang Jae Hyun, Son Il Tae, Kim Byung Chun, Park Jun Ho, Kim Jeong Yeon, Kim Jong Wan
机构信息
Department of Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong-si, Gyeonggi, 445-170, Republic of Korea.
Department of Surgery, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, 445-907, Republic of Korea.
出版信息
Cancer Manag Res. 2022 Jun 20;14:2031-2040. doi: 10.2147/CMAR.S358939. eCollection 2022.
BACKGROUND
T4 tumor, lymphovascular invasion (LVI) and perineural invasion (PNI) are regarded as one of risk factors and associated with poor outcomes in colorectal cancer. The relationship between these three combined risk factors and the prognosis for colon cancer is not yet clear. The purpose of this study was to evaluate the prognostic value of combining the risk factors T4 tumor, LVI, and PNI in stage II-III colon cancer.
METHODS
Between January 2011 and December 2019, we retrospectively reviewed the medical records of patients who underwent curative resection for stage II-III colon cancer at four Hallym University-affiliated hospitals. These patients are categorized into three groups based on T4, LVI and PNI: no-risk group (no risk factors), low-risk group (one risk factor), and high-risk group (two or more risk factors).
RESULTS
Of 1684 patients, the incidence of no-, low-, and high-risk group were 49.3%, 32.6%, 18.0%, respectively. The median follow-up period was 48.9 months, and the 5-year recurrence-free survival (RFS) rate decreased from 78.5% to 58.7% as the number of risk factors increased (P < 0.001). Cox's proportional hazard regression models showed that T4 (P < 0.001), LVI (P = 0.043), and PNI (P = 0.018) were independent prognostic factors for poor RFS. In subgroup analysis in stage II colon cancer, patients with one or more risk factors showed the better 5-year RFS rate when they received adjuvant chemotherapy than in those who did not (P < 0.001). Poor/mucinous differentiation, obstruction, and lymph-node positivity were independent predictors in the high risk group.
CONCLUSION
The present study showed the histological combination of LVI, PNI, and T4 indicates a poor prognosis for RFS in patients with stage II-III colon cancer. Therefore, patients with one of these risk factors should be considered for chemotherapy and have close follow-up.
背景
T4肿瘤、淋巴管侵犯（LVI）和神经周围侵犯（PNI）被视为危险因素之一，与结直肠癌的不良预后相关。这三个联合危险因素与结肠癌预后之间的关系尚不清楚。本研究的目的是评估联合T4肿瘤、LVI和PNI危险因素对II-III期结肠癌预后的价值。
方法
2011年1月至2019年12月，我们回顾性分析了四所韩林大学附属医院接受II-III期结肠癌根治性切除术患者的病历。根据T4、LVI和PNI将这些患者分为三组：无风险组（无危险因素）、低风险组（一个危险因素）和高风险组（两个或更多危险因素）。
结果
1684例患者中，无风险组、低风险组和高风险组的发生率分别为49.3%、32.6%、18.0%。中位随访期为48.9个月，随着危险因素数量的增加，5年无复发生存率（RFS）从78.5%降至58.7%（P<0.001）。Cox比例风险回归模型显示，T4（P<0.001）、LVI（P=0.043）和PNI（P=0.018）是RFS不良的独立预后因素。在II期结肠癌亚组分析中，有一个或多个危险因素的患者接受辅助化疗时的5年RFS率高于未接受辅助化疗的患者（P<0.001）。高风险组中，低分化/黏液分化、梗阻和淋巴结阳性是独立的预测因素。
结论
本研究表明，LVI、PNI和T4的组织学组合表明II-III期结肠癌患者RFS预后不良。因此，有这些危险因素之一的患者应考虑化疗并密切随访。
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