在一项全国范围内基于人群的研究中，结肠癌的肿瘤沉积可预测复发和降低存活率。
Tumour deposits in colon cancer predict recurrence and reduced survival in a nationwide population-based study.
机构信息
Department of Surgery, Helsingborg Hospital, Lund University, Helsingborg, Sweden.
Department of Surgery, Skåne University Hospital, Malmö, Lund University, Malmö, Sweden.
出版信息
BJS Open. 2023 Nov 1;7(6). doi: 10.1093/bjsopen/zrad122.
BACKGROUND
Tumour deposits are suggested to impact prognosis in colon cancer negatively. This study assessed the impact of tumour deposits on oncological outcomes.
METHODS
Data from the Swedish Colorectal Cancer Registry for patients who underwent R0 abdominal surgery for TNM stage I-III colon cancer between 2011 and 2014 with 5-year follow-up were analysed with multivariable analysis. Patients were categorized for their tumour deposit status and compared for the local recurrence and distant metastasis rates and 5-year survivals (overall and relative). Subgroup analyses were performed according to the nodal disease status.
RESULTS
Of 8146 stage I-III colon cancer patients who underwent R0 resection, 8014 patients were analysed (808 tumour deposits positive, 7206 tumour deposits negative). Patients with tumour deposits positive tumours had increased local recurrence and distant metastasis rates (7.2 versus 3.0 per cent; P < 0.001 and 33.9 versus 12.0 per cent; P < 0.001 respectively) and reduced 5-year overall and relative survival (56.8 per cent versus 74.9 per cent; P < 0.001 and 68.5 versus 92.6 per cent; P < 0.001 respectively). In multivariable analysis, tumour deposits moderately increased the risks of local recurrence and distant metastasis (hazard ratio 1.50, 95 per cent c.i. 1.09 to 2.07; P = 0.013 and HR 1.91, 95 per cent c.i. 1.64 to 2.23; P < 0.001 respectively) and worse 5-year overall and relative survival (hazard ratio 1.60, 95 per cent c.i. 1.40 to 1.82; P < 0.001 and excess hazard ratio 2.24, 95 per cent c.i. 1.81 to 2.78; P < 0.001 respectively). Subgroup analysis of N stages found that N1c patients had worse outcomes than N0 for distant metastasis and relative survival. For patients with lymph node metastases tumour deposits increased the risks of distant metastasis and worse overall and relative survival, except for N2b patients.
CONCLUSION
Tumour deposits negatively impact the prognosis in colon cancer and must be considered when discussing adjuvant chemotherapy.
背景
肿瘤沉积物被认为会对结肠癌的预后产生负面影响。本研究评估了肿瘤沉积物对肿瘤学结果的影响。
方法
对 2011 年至 2014 年间接受 TNM 分期 I-III 期结肠癌 RO 腹部手术且随访 5 年的瑞典结直肠癌登记处患者的数据进行了多变量分析。根据肿瘤沉积物状态对患者进行分类，并比较局部复发和远处转移率以及 5 年生存率（总生存率和相对生存率）。根据淋巴结疾病状态进行亚组分析。
结果
在 8146 例接受 RO 切除术的 I-III 期结肠癌患者中，分析了 8014 例患者（808 例肿瘤沉积物阳性，7206 例肿瘤沉积物阴性）。肿瘤沉积物阳性肿瘤患者的局部复发和远处转移率增加（分别为 7.2%和 3.0%；P<0.001和 33.9%和 12.0%；P<0.001），5 年总生存率和相对生存率降低（分别为 56.8%和 74.9%；P<0.001和 68.5%和 92.6%；P<0.001）。多变量分析显示，肿瘤沉积物适度增加了局部复发和远处转移的风险（风险比 1.50，95%置信区间 1.09 至 2.07；P=0.013 和 HR 1.91，95%置信区间 1.64 至 2.23；P<0.001），5 年总生存率和相对生存率降低（风险比 1.60，95%置信区间 1.40 至 1.82；P<0.001 和超额风险比 2.24，95%置信区间 1.81 至 2.78；P<0.001）。N 分期的亚组分析发现，N1c 患者的远处转移和相对生存率比 N0 患者差。对于有淋巴结转移的患者，肿瘤沉积物增加了远处转移和较差的总生存率和相对生存率的风险，但 N2b 患者除外。
结论
肿瘤沉积物对结肠癌的预后有负面影响，在讨论辅助化疗时必须考虑到这一点。
Zotero 插件