半结肠切除术与II期结直肠癌生存率的关联:一项回顾性队列研究。

Association of hemicolectomy with survival in stage II colorectal cancer: a retrospective cohort study.

作者信息

Zeng Hao, Chen Yongtai, Lan Qilong, Lu Geng, Chen Dongbo, Li Fudi, Xu Dongbo, Lin Shuangming

机构信息

Fujian Medical University, Fuzhou, China.

Department of Hepatobiliary Pancreatic Abdominal Wall Hernia Surgery, Longyan First Hospital, Fujian Medical University, Longyan, China.

出版信息

Updates Surg. 2023 Dec;75(8):2211-2223. doi: 10.1007/s13304-023-01646-w. Epub 2023 Nov 24.

Abstract

To compare the oncological survival outcomes of partial colectomy (PC) and hemicolectomy (HC) in patients with stage II colon cancer. A total of 18,795 patients with stage II colon cancer who underwent hemicolectomy (n = 12,022) or partial colectomy (n = 6773) from 2010 to 2019 were included in the the Surveillance, Epidemiology, and End Results (SEER) database. Overall survival (OS) and cancer-specific survival (CSS) were compared between the two groups, and the threshold of harvested lymph nodes was determined. The results showed that age, gender, race, tumor site, scope of regional lymph nodes, postoperative chemotherapy, postoperative radiotherapy, harvested lymph nodes, and tumor size were significantly different between the PC and HC groups (all P < 0.05). The OS rate was slightly lower in hemicolectomy patients than in partial colectomy patients (69.9% vs. 74.5%, respectively, P < 0.001), but CSS was similar between the two groups (87.9% vs. 88.1%, respectively, P = 0.32). After propensity score matching (PSM) was performed, the OS and CSS rates in the two groups were significantly different (CSS 84.3% vs. 88.0%, P < 0.001; OS 62.2% vs. 72.5%, P < 0.001). The survminer R package determined that the optimum threshold for the harvested lymph node count in stage II colon cancer patients was 16. CSS was significantly different between patients with ≥ 12 lymph nodes harvested and patients with ≥ 16 lymph nodes harvested (P = 0.043). Univariate and multivariate Cox regression and survival analyses of stage II colon cancer patients showed that the survival benefit of stage II colon cancer patients receiving partial colectomy was superior to that of patients receiving hemicolectomy. Partial colectomy has significant oncological benefits over hemicolectomy in the treatment of stage II colon cancer patients, even in the case of pT4b or tumor deposits. Removal of 16 lymph nodes during colectomy for stage II colon cancer correlated with improved survival, and this threshold was more effective than the standard threshold of 12 lymph nodes in distinguishing between patients with good and poor prognoses.

摘要

比较II期结肠癌患者行部分结肠切除术(PC)和半结肠切除术(HC)后的肿瘤学生存结局。2010年至2019年期间,共有18795例行半结肠切除术(n = 12022)或部分结肠切除术(n = 6773)的II期结肠癌患者被纳入监测、流行病学和最终结果(SEER)数据库。比较两组患者的总生存期(OS)和癌症特异性生存期(CSS),并确定清扫淋巴结的阈值。结果显示,PC组和HC组在年龄、性别、种族、肿瘤部位、区域淋巴结范围、术后化疗、术后放疗、清扫淋巴结数量和肿瘤大小方面存在显著差异(所有P < 0.05)。半结肠切除术患者的OS率略低于部分结肠切除术患者(分别为69.9%和74.5%,P < 0.001),但两组的CSS相似(分别为87.9%和88.1%,P = 0.32)。进行倾向评分匹配(PSM)后,两组的OS和CSS率存在显著差异(CSS:84.3%对88.0%,P < 0.001;OS:62.2%对72.5%,P < 0.001)。survminer R包确定II期结肠癌患者清扫淋巴结计数的最佳阈值为16。清扫淋巴结≥12个的患者与清扫淋巴结≥16个的患者之间的CSS存在显著差异(P = 0.043)。对II期结肠癌患者进行单因素和多因素Cox回归及生存分析显示,接受部分结肠切除术的II期结肠癌患者的生存获益优于接受半结肠切除术的患者。在II期结肠癌患者的治疗中,部分结肠切除术比半结肠切除术具有显著的肿瘤学益处,即使在pT4b或有肿瘤种植的情况下也是如此。II期结肠癌手术中清扫16枚淋巴结与生存改善相关,该阈值在区分预后良好和预后不良的患者方面比标准的12枚淋巴结阈值更有效。

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