Su Hongbo, Xie Shuping, Wang Shanshan, Huang Liying, Lyu Jun, Pan Yunlong
Department of General Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.
Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China.
Front Med (Lausanne). 2024 Jan 31;11:1301487. doi: 10.3389/fmed.2024.1301487. eCollection 2024.
Competing-risk analysis was used to accurately assess prognostic factors for cancer-specific death in patients with adenocarcinoma of transverse colon (ATC), and the results were compared with those from a conventional Cox regression analysis.
Patients diagnosed with ATC between 2000 and 2019 were selected from the Surveillance, Epidemiology, and End Results database. The crude mortality rates of patients with ATC were calculated and their differences were tested using the Gray's test, respectively. In performing multivariate analysis, the Cox regression model and the subdistribution hazard function (SD) in competing risk analysis were utilized, respectively.
This study included 21,477 eligible patients. The SD model indicated that age, etc. are actual independent prognostic factors. In contrast to previous recognition, the results of the Cox regression showed false-positives for sex and Carcinoembryonic antigen, and underestimated point-estimates in the stage and American Joint Committee on Cancer stage due to competing events. A detailed comparison of treatment revealed that the larger surgical scopes were prognostic risk factors compared with the smaller scope of local tumor excision, partial colectomy, or segmental resection. Patients treated with external proton beam radiotherapy had an increased risk compared with those with no radiotherapy and internal radiotherapy.
After comparing the results of the two methods and mitigating the significant bias introduced by Cox regression, we found independent factors that really affect the prognosis of ATC. On the other hand, in terms of ATC, a larger surgical scope and external proton beam radiotherapy may not improve the long-term survival of patients. Therefore, when faced with ATC patients, these differences should be noted and treated differently from common colorectal cancer patients. Thus, clinicians are able to give more targeted treatment plans and prognostic assessments.
采用竞争风险分析准确评估横结肠癌（ATC）患者癌症特异性死亡的预后因素，并将结果与传统Cox回归分析的结果进行比较。
从监测、流行病学和最终结果数据库中选取2000年至2019年诊断为ATC的患者。计算ATC患者的粗死亡率，并分别使用Gray检验检验其差异。在进行多变量分析时，分别使用Cox回归模型和竞争风险分析中的亚分布风险函数（SD）。
本研究纳入21477例符合条件的患者。SD模型表明年龄等是实际的独立预后因素。与以往的认识相反，Cox回归的结果显示性别和癌胚抗原存在假阳性，并且由于竞争事件，在分期和美国癌症联合委员会分期中低估了点估计值。治疗的详细比较显示，与局部肿瘤切除范围较小、部分结肠切除术或节段性切除术相比，手术范围较大是预后危险因素。接受外部质子束放疗的患者与未接受放疗和内部放疗患者相比，风险增加。
在比较两种方法的结果并减轻Cox回归引入的显著偏差后，我们发现了真正影响ATC预后的独立因素。另一方面，就ATC而言，较大的手术范围和外部质子束放疗可能无法改善患者的长期生存。因此，面对ATC患者时，应注意这些差异，并与常见的结直肠癌患者区别对待。这样，临床医生能够给出更有针对性的治疗方案和预后评估。
