Department of General Surgery, Aerospace Center Hospital, Haidian, Beijing, China.
Department of Breast Surgery, Peking University Cancer Hospital, Haidian, Beijing, China.
BMJ Open. 2024 Feb 29;14(2):e076579. doi: 10.1136/bmjopen-2023-076579.
Colorectal cancer (CRC) encompasses a spectrum of pathological types, each exhibiting distinct biological behaviours that challenge the conventional T-staging system's predictive efficiency. Thus, this study aims to explore the prognostic significance of the T stage across various CRC pathological types, seeking to unravel insights that could enhance prognostic assessment in this complex disease.
We performed a retrospective analysis using the Surveillance, Epidemiology, and End Results (SEER) database for primary CRC cases from 2010 to 2017.
The SEER database, comprising data from various US regional and state cancer registries, identified 39 321 patients with CRC. Our analysis focused on the three most common CRC pathological types: adenocarcinoma (AC), mucinous adenocarcinoma (MC) and signet ring cell carcinoma (SR).
The study used Cox regression models to evaluate how different pathological characteristics impact mortality risk in patients with CRC. Time-dependent receiver operating characteristic curves were also applied to assess the prognostic accuracy of various tumour node metastasis (TNM)/non-mucinous (NM) stages.
We observed significant associations between T stage and mortality risk for patients with AC and MC. Notably, in comparison to those at T1 stage, patients with AC in the T4 stage demonstrated a 2.01-fold increase in mortality risk (HR=2.01, 95% CI: 1.89 to 2.15), while patients with MC at T4 stage showed a 1.42-fold increase (HR=1.42, 95% CI: 1.03 to 1.97). However, within the SR group, T stages did not independently impact survival, showing no significant distinction (HR=1.07, 95% CI: 0.59 to 1.95). Intriguingly, the traditional TNM staging systems demonstrated limited discriminatory power in predicting prognosis for patients with SR when compared with the more innovative NM staging systems.
This study uncovers important insights about the prognostic significance of the T stage in different types of CRC, highlighting the need for personalised assessments based on specific histological subtypes.
结直肠癌（CRC）包含一系列病理类型，每种类型都表现出不同的生物学行为，这对传统 T 分期系统的预测效率提出了挑战。因此，本研究旨在探讨不同 CRC 病理类型的 T 分期的预后意义，旨在深入了解这一复杂疾病的预后评估。
我们使用 2010 年至 2017 年的监测、流行病学和最终结果（SEER）数据库对原发性 CRC 病例进行了回顾性分析。
SEER 数据库由美国多个地区和州癌症登记处的数据组成，共确定了 39321 例 CRC 患者。我们的分析重点是三种最常见的 CRC 病理类型：腺癌（AC）、黏液腺癌（MC）和印戒细胞癌（SR）。
本研究使用 Cox 回归模型评估不同病理特征对 CRC 患者死亡风险的影响。还应用时间依赖性接收者操作特征曲线评估各种肿瘤淋巴结转移（TNM）/非黏液（NM）分期的预后准确性。
我们观察到 T 分期与 AC 和 MC 患者的死亡率之间存在显著关联。值得注意的是，与 T1 期患者相比，T4 期 AC 患者的死亡率风险增加了 2.01 倍（HR=2.01，95%CI：1.89 至 2.15），而 T4 期 MC 患者的死亡率风险增加了 1.42 倍（HR=1.42，95%CI：1.03 至 1.97）。然而，在 SR 组中，T 分期并未独立影响生存，无显著差异（HR=1.07，95%CI：0.59 至 1.95）。有趣的是，与更具创新性的 NM 分期系统相比，传统的 TNM 分期系统在预测 SR 患者的预后方面显示出有限的区分能力。
本研究揭示了 T 分期在不同类型 CRC 中的预后意义的重要见解，强调了基于特定组织学亚型进行个性化评估的必要性。
