Pang Xiangyi, Xu Benjie, Lian Jie, Wang Ren, Wang Xin, Shao Jiayue, Tang Shuli, Lu Haibo
Department of Outpatient Chemotherapy, Harbin Medical University Cancer Hospital, Harbin, China.
Front Oncol. 2022 Sep 16;12:914076. doi: 10.3389/fonc.2022.914076. eCollection 2022.
The survival rate for colon cancer after radical surgery has been the focus of extensive debate. To assess the postoperative survival and prognostic factors for overall survival (OS), we collected clinicopathological information for 2,655 patients. The survival time and potential risk factors for OS were analyzed by using Kaplan-Meier curves, Cox proportional hazards models, best subset regression (BSR), and least absolute shrinkage and selection operator (LASSO). The 5-year survival rates of stage I-IV colon cancer were 96.6%, 88.7%, 69.9%, and 34.3%, respectively. Adjuvant chemotherapy improved the survival rate (90.4% vs. 82.4%, with versus without adjuvant chemotherapy, respectively) in stage II patients with high-risk factors. Elevated preoperative carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) were significantly associated with worse OS compared with patients without these elevations. Less than 12 versus more than 12 harvested lymph nodes (LNs) affected prognosis (84.6% vs. 89.7%, respectively). Regarding the lymph node ratio (LNR), the 5-year OS rate was 89.2%, 71.5%, 55.8%, and 34.5% in patients with LNR values of 0, 0.3, 0.3-0.7, and >0.7, respectively. We constructed a nomogram comprising the independent factors associated with survival to better predict prognosis. On the basis of these findings, we propose that stage II colon cancer patients without high-risk factors and with both elevated preoperative CEA and CA199 should receive adjuvant therapy. Furthermore, the LNR could complement TNM staging in patients with <12 harvested LNs. Our nomogram might be useful as a new prognosis prediction system for colon cancer patients.
根治性手术后结肠癌的生存率一直是广泛争论的焦点。为了评估术后生存率及总生存(OS)的预后因素,我们收集了2655例患者的临床病理信息。采用Kaplan-Meier曲线、Cox比例风险模型、最佳子集回归(BSR)和最小绝对收缩和选择算子(LASSO)分析了OS的生存时间和潜在风险因素。I-IV期结肠癌的5年生存率分别为96.6%、88.7%、69.9%和34.3%。辅助化疗提高了具有高危因素的II期患者的生存率(分别为90.4%和82.4%,有辅助化疗与无辅助化疗)。与未出现这些升高的患者相比,术前癌胚抗原(CEA)和糖类抗原19-9(CA19-9)升高与更差的OS显著相关。少于12枚与多于12枚的清扫淋巴结(LNs)影响预后(分别为84.6%和89.7%)。关于淋巴结比率(LNR),LNR值为0、0.3、0.3-0.7和>0.7的患者的5年OS率分别为89.2%、71.5%、55.8%和34.5%。我们构建了一个包含与生存相关的独立因素的列线图,以更好地预测预后。基于这些发现,我们建议无高危因素且术前CEA和CA199均升高的II期结肠癌患者应接受辅助治疗。此外,LNR可补充清扫LNs少于12枚患者的TNM分期。我们的列线图可能作为一种新的结肠癌患者预后预测系统有用。
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