Tian Mengxiang, Zhou Zhongyi
Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
Transl Cancer Res. 2022 Dec;11(12):4241-4253. doi: 10.21037/tcr-22-1630.
Colon cancer is one of the most common tumor diseases in the world. Currently, clinicians usually evaluate the survival and prognosis of patients according to their tumor-node-metastasis (TNM) stage. However, current studies have found that there is a certain survival paradox in TNM staging.
In the Surveillance, Epidemiology, and End Results (SEER) database, patients diagnosed with colon cancer by surgical pathology from 2004 to 2011 were selected for analysis of 5-year overall survival (OS). Propensity score matching (PSM) was performed to analyze the difference in survival between different stages and the effect of chemotherapy on prognosis.
The OS of stage IIIA colon cancer sufferers was significantly superior to stage IIB/IIC and separate stage IIB or IIC colon cancer patients before and after PSM analysis (P<0.05 for all). Moreover, the difference in survival was more significant when stage IIB/IIC patients were compared with stage IIIA patients with chemotherapy.
The survival paradox existed both in all stage IIB/IIC patients, or individual stage IIB or IIC patients compared with stage IIIA sufferers, and the survival paradox between stage IIIA and stage IIC was more obvious. Moreover, chemotherapy had a positive effect on the prognosis of patients with stage IIIA, IIC and IIB in this study. Chemotherapy exacerbates the survival paradox of colon cancer, even if it is not the cause of the survival paradox.
结肠癌是世界上最常见的肿瘤疾病之一。目前，临床医生通常根据患者的肿瘤-淋巴结-转移（TNM）分期来评估其生存和预后。然而，目前的研究发现TNM分期存在一定的生存悖论。
在监测、流行病学和最终结果（SEER）数据库中，选取2004年至2011年经手术病理诊断为结肠癌的患者进行5年总生存（OS）分析。进行倾向评分匹配（PSM）以分析不同分期之间的生存差异以及化疗对预后的影响。
在PSM分析前后，IIIA期结肠癌患者的OS均显著优于IIB/IIC期以及单独的IIB期或IIC期结肠癌患者（所有P<0.05）。此外，将IIB/IIC期患者与接受化疗的IIIA期患者进行比较时，生存差异更为显著。
与IIIA期患者相比，所有IIB/IIC期患者或个体IIB期或IIC期患者均存在生存悖论，且IIIA期与IIC期之间的生存悖论更为明显。此外，在本研究中，化疗对IIIA期、IIC期和IIB期患者的预后有积极作用。化疗加剧了结肠癌的生存悖论，即使它不是生存悖论的原因。
