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淋巴结获取不足:II期结肠癌辅助化疗的不充分指征

Inadequate Lymph Node Yield: An Inadequate Indication for Adjuvant Chemotherapy in Stage II Colon Cancer.

作者信息

Zambeli-Ljepović Alan, Hoffman Daniel, Barnes Katherine E, Romero-Hernandez Fernanda, Ashraf Ganjouei Amir, Adam Mohamed A, Sarin Ankit

机构信息

From the Department of Surgery, University of California, San Francisco, San Francisco, CA.

Department of Surgery, University of California Davis, Sacramento, CA.

出版信息

Ann Surg Open. 2023 Oct 2;4(4):e338. doi: 10.1097/AS9.0000000000000338. eCollection 2023 Dec.

Abstract

BACKGROUND

Optimal therapy for stage II colon cancer remains unclear, and national guidelines recommend "consideration" of adjuvant chemotherapy (ACT) in the presence of high-risk features, including inadequate lymph node yield (LNY, <12 nodes). This study aims to determine whether the survival benefit of ACT in stage II disease varies based on the adequacy of LNY.

METHODS

We used the National Cancer Database (NCDB) to identify adults who underwent resection for a single primary T3 or T4 colon cancer between 2006 and 2018. Multivariable logistic regression tested for associations between ACT and prespecified demographic and clinical characteristics, including the adequacy of LNY. We used Cox proportional hazards models to assess overall survival and restricted cubic splines to estimate the optimal LNY threshold to dichotomize patients based on overall survival.

RESULTS

Unadjusted 5- and 10-year survival rates were 84% and 75%, respectively, among patients who received ACT and 70% and 50% among patients who did not (log-rank < 0.01). Inadequate LNY was independently associated with both receipt of ACT (odds ratios, 1.50; < 0.01) and decreased overall survival [hazard ratio (HR), 1.56; < 0.01]. ACT was independently associated with improved survival (HR, 0.67; < 0.01); this effect size did not change based on the adequacy of LNY (interaction = 0.41). Results were robust to re-analysis with our cohort-optimized threshold of 18 lymph nodes.

CONCLUSIONS

Consistent with contemporary guidelines, patients with inadequate LNY are more likely to receive ACT. LNY adequacy is an independent prognostic factor but, in isolation, should not dictate whether patients receive ACT.

摘要

背景

II期结肠癌的最佳治疗方案仍不明确,国家指南建议在存在高风险特征时“考虑”辅助化疗(ACT),这些高风险特征包括淋巴结获取量不足(LNY,<12枚淋巴结)。本研究旨在确定II期疾病中ACT的生存获益是否因LNY是否充足而有所不同。

方法

我们使用国家癌症数据库(NCDB)来识别2006年至2018年间接受单一原发性T3或T4结肠癌切除术的成年人。多变量逻辑回归测试了ACT与预先指定的人口统计学和临床特征之间的关联,包括LNY是否充足。我们使用Cox比例风险模型评估总生存期,并使用受限立方样条来估计基于总生存期将患者二分的最佳LNY阈值。

结果

接受ACT的患者未调整的5年和10年生存率分别为84%和75%,未接受ACT的患者分别为70%和50%(对数秩检验P<0.01)。LNY不足与接受ACT(比值比,1.50;P<0.01)和总生存期降低均独立相关[风险比(HR),1.56;P<0.01]。ACT与生存率提高独立相关(HR,0.67;P<0.01);这种效应大小不会因LNY是否充足而改变(交互作用P=0.41)。使用我们队列优化的18枚淋巴结阈值进行重新分析时,结果依然稳健。

结论

与当代指南一致,LNY不足的患者更有可能接受ACT。LNY是否充足是一个独立的预后因素,但仅凭这一点不应决定患者是否接受ACT。

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