Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Denmark.
Department of Pathology, Rigs Hospital, University of Copenhagen, Denmark.
Acta Oncol. 2023 Jun;62(6):594-600. doi: 10.1080/0284186X.2023.2218555. Epub 2023 Jun 2.
Microscopically positive margins to lymph node metastases (R1LNM) are associated with poorer oncological outcomes in patients with Stage 3 colon cancer. These poorer outcomes were seen despite a greater proportion of these patients receiving adjuvant chemotherapy when compared to those with microscopically negative (R0) margins. We sought to determine if differences in the type or duration of adjuvant chemotherapy could account for the differences in outcomes seen between patients with R0 and R1LNM margins.
A multicentre retrospective study including patients undergoing surgery for Stage 3 colon cancer between 2016-2019 at specialist centres. Patients were stratified according to margins status (R0 vs R1LNM). Type/duration of chemotherapy and oncological outcomes were compared between groups.
718 patients were included, of whom 100 had R1LNM margins (13.1%). Patients with R1LNM margins had significantly poorer 3-year distant metastases-free (R0 78.2% (95% CI 74.5-81.3) versus R1LNM 58.8% (95% CI 47.2-68.6), < 0.001) and disease specific survival (R0 88.3% (95% CI 85.2-90.9) versus R1LNM 78.5% (95% CI 68.0-85.8), < 0.001) when compared to those with R0 margins. No differences were noted in the proportion of patients who completed long-course chemotherapy or were treated with oxaliplatin-based combinations between the R1LNM and R0 groups. Differences in outcomes between R0 and R1LNM groups persisted even when only those patients who completed long-course chemotherapy were compared.
Differences in adjuvant chemotherapy do not appear to account for the poorer oncological outcomes seen in patients with R1LNM margins after surgery for Stage 3 colon cancer. This suggests that adjuvant chemotherapy may be less effective in this patient group. Further studies to elucidate a potential biological basis for this difference are warranted.
显微镜下淋巴结转移阳性边缘（R1LNM）与 III 期结肠癌患者的肿瘤学预后较差相关。尽管这些患者中接受辅助化疗的比例高于显微镜下阴性（R0）边缘的患者，但仍出现了这些较差的结果。我们试图确定辅助化疗的类型或持续时间的差异是否可以解释 R0 和 R1LNM 边缘患者之间观察到的结果差异。
一项多中心回顾性研究，纳入了 2016 年至 2019 年间在专业中心接受 III 期结肠癌手术的患者。根据边缘状态（R0 与 R1LNM）对患者进行分层。比较两组间化疗类型/持续时间和肿瘤学结局。
共纳入 718 例患者，其中 100 例患者有 R1LNM 边缘（13.1%）。R1LNM 边缘患者的 3 年远处无转移（R0 78.2%（95%CI 74.5-81.3）与 R1LNM 58.8%（95%CI 47.2-68.6），<0.001）和疾病特异性生存（R0 88.3%（95%CI 85.2-90.9）与 R1LNM 78.5%（95%CI 68.0-85.8），<0.001）明显较差。R1LNM 与 R0 边缘患者相比，完成长疗程化疗或接受奥沙利铂为基础联合化疗的患者比例无差异。即使仅比较完成长疗程化疗的患者，R0 和 R1LNM 组之间的结局差异仍然存在。
辅助化疗的差异似乎不能解释 III 期结肠癌手术后 R1LNM 边缘患者的肿瘤学结局较差。这表明辅助化疗在该患者群体中的效果可能较差。需要进一步研究阐明这种差异的潜在生物学基础。
