Department of Surgery, Howard University College of Medicine, Washington, DC, USA.
Louisiana Tumor Registry and Epidemiology Program, School of Public Health, Louisiana State University Health Sciences Center-New Orleans, New Orleans, LA, USA.
Surg Endosc. 2024 May;38(5):2857-2870. doi: 10.1007/s00464-024-10723-z. Epub 2024 Apr 4.
A survival paradox between T4N0 (Stage IIB/IIC) and Stage IIIA colon cancer exists, even after adjusting for adequate lymph node (LN) retrieval and receipt of adjuvant chemotherapy (C). We conducted a large hospital-based study to re-evaluate this survival paradox based on the newest 8th edition staging system.
The National Cancer Data Base was queried to evaluate 35,606 patients diagnosed with Stage IIB, IIC, and IIIA colon cancer between 2010 and 2017. The Kaplan-Meier method and log-rank test were used to compare unadjusted overall survival (OS). Multivariable Cox proportional hazards model was used to determine the association of stage with hazard ratios adjusted for relevant demographic and clinical variables including ≥ 12 LNs retrieved and receipt of adjuvant chemotherapy. P value < 0.05 was considered statistically significant.
The 5-year OS for optimally treated stage IIIA colon cancer (receipt of C) was 84.3%, which was significantly higher than stage IIB/C (≥ 12 LNs retrieved + C) (72.8%; P < 0.0001). Stage was an independent predictor of OS. Among optimally treated Stage IIIA patients, T1N1 had the best survival (90.6%) while stage T4bN0 (stage IIC) had the worst (70.9%) (P < 0.0001). Compared to stage IIB, stage IIC had a 17% increased risk of overall death while stage IIIA had a 21% reduction in death (P < 0.0001).
Stage IIB/C and Stage IIIA survival paradox persists even after accounting for receipt of adjuvant chemotherapy and adequate lymph node retrieval. Future iteration of the TNM system should take this paradox into consideration.
即使考虑到充分的淋巴结（LN）取样和接受辅助化疗（C），T4N0（IIB/IIC 期）和 IIIA 期结肠癌之间仍存在生存悖论。我们进行了一项大型基于医院的研究，根据最新的第 8 版分期系统重新评估这种生存悖论。
国家癌症数据库被用来评估 2010 年至 2017 年间诊断为 IIB、IIC 和 IIIA 期结肠癌的 35606 例患者。Kaplan-Meier 法和对数秩检验用于比较未调整的总生存期（OS）。多变量 Cox 比例风险模型用于确定分期与相关人口统计学和临床变量（包括≥12 个 LN 取样和接受辅助化疗）调整后的危险比之间的关联。P 值<0.05 被认为具有统计学意义。
最佳治疗的 IIIA 期结肠癌（接受 C）的 5 年 OS 为 84.3%，明显高于 IIB/C 期（≥12 个 LN 取样+C）（72.8%；P<0.0001）。分期是 OS 的独立预测因素。在最佳治疗的 IIIA 期患者中，T1N1 患者的生存情况最好（90.6%），而 T4bN0 期（IIC 期）患者的生存情况最差（70.9%）（P<0.0001）。与 IIB 期相比，IIC 期的总体死亡风险增加了 17%，而 IIIA 期的死亡风险降低了 21%（P<0.0001）。
即使考虑到接受辅助化疗和充分的淋巴结取样，IIB/C 和 IIIA 期的生存悖论仍然存在。TNM 系统的未来迭代应该考虑到这一悖论。
