Golder Allan M, Conlan Owen, McMillan Donald C, Mansouri David, Horgan Paul G, Roxburgh Campbell S
Academic Unit of Surgery-Glasgow Royal Infirmary, Glasgow, UK.
Ann Surg. 2023 Nov 1;278(5):e1018-e1025. doi: 10.1097/SLA.0000000000005872. Epub 2023 Apr 10.
To examine the association between tumor/host factors (including the systemic inflammatory response), mode of presentation, and short/long-term outcomes in patients undergoing curative resectional surgery for TNM I to III colon cancer.
Emergency presentations of colon cancer are associated with worse long-term outcomes than elective presentations despite adjustment for TNM stage. A number of differences in tumor and host factors have been identified between elective and emergency presentations and it may be these factors that are associated with adverse outcomes.
Patients undergoing curative surgery for TNM I to III colon cancer in the West of Scotland from 2011 to 2014 were identified. Tumor/host factors independently associated with the emergency presentation were identified and entered into a subsequent survival model to determine those that were independently associated with overall survival/cancer-specific survival (OS/CSS).
A total of 2705 patients were identified. The emergency presentation was associated with a worse 3-year OS and CSS compared with elective presentations (70% vs 86% and 91% vs 75%). T stage, age, systemic inflammatory grade, anemia (all P < 0.001), N stage ( P = 0.077), extramural venous invasion ( P = 0.003), body mass index ( P = 0.001), and American Society of Anesthesiologists Classification classification ( P = 0.021) were independently associated with emergency presentation. Of these, body mass index [hazard ratio (HR), 0.82], American Society of Anesthesiologists Classification (HR, 1.45), anemia (HR, 1.29), systemic inflammatory grade (HR. 1.11), T stage (HR, 1.57), N stage (HR, 1.80), and adjuvant chemotherapy (HR, 0.47) were independently associated with OS. Similar results were observed for CSS.
Within patients undergoing curative surgery for colon cancer, the emergency presentation was not independently associated with worse OS/CSS. Rather, a combination of tumor and host factors account for the worse outcomes observed.
探讨接受根治性切除手术的Ⅰ至Ⅲ期结肠癌患者的肿瘤/宿主因素（包括全身炎症反应）、临床表现方式与短期/长期预后之间的关联。
尽管对TNM分期进行了调整，但结肠癌的急诊表现与择期表现相比，长期预后更差。在择期和急诊表现之间已发现肿瘤和宿主因素存在一些差异，可能正是这些因素与不良预后相关。
确定2011年至2014年在苏格兰西部接受Ⅰ至Ⅲ期结肠癌根治性手术的患者。确定与急诊表现独立相关的肿瘤/宿主因素，并将其纳入后续生存模型，以确定那些与总生存/癌症特异性生存（OS/CSS）独立相关的因素。
共确定了2705例患者。与择期表现相比，急诊表现的3年总生存率和癌症特异性生存率更差（分别为70%对86%和91%对75%）。T分期、年龄、全身炎症分级、贫血（均P<0.001）、N分期（P = 0.077）、壁外静脉侵犯（P = 0.003）、体重指数（P = 0.001）和美国麻醉医师协会分级（P = 0.021）与急诊表现独立相关。其中，体重指数[风险比（HR），0.82]、美国麻醉医师协会分级（HR，1.45）、贫血（HR，1.29）、全身炎症分级（HR，1.11）、T分期（HR，1.57）、N分期（HR，1.80）和辅助化疗（HR，0.47）与总生存独立相关。癌症特异性生存也观察到类似结果。
在接受结肠癌根治性手术的患者中，急诊表现与更差的总生存/癌症特异性生存并非独立相关。相反，肿瘤和宿主因素的综合作用导致了观察到的更差预后。
