Sorbonne université, Departement of Medical Oncology, Saint Antoine Hospital, APHP, Paris, France; INSERM, Unité Mixte de Recherche Scientifique 938 and SIRIC CURAMUS, Centre de Recherche Saint-Antoine, Equipe Instabilité des Microsatellites et Cancer, Equipe labellisée par la Ligue Nationale contre le Cancer, Sorbonne Université, Paris, France.
Sorbonne université, Departement of Medical Oncology, Saint Antoine Hospital, APHP, Paris, France.
Clin Colorectal Cancer. 2024 Dec;23(4):346-353.e1. doi: 10.1016/j.clcc.2024.05.005. Epub 2024 May 24.
Stage II colon cancer (CC) exhibits considerable prognostic heterogeneous. Our objective was to assess survival but also the prognosis impact of microsatellite instability (MSI) in patients with stage IIC (T4bN0M0) CC.
We conducted a retrospective observational study including all patients who had primary stage IIC CC resection between 2010 and 2020 in 2 expert centers. The primary endpoint was overall survival (OS) and disease-free survival (DFS) and time-to-relapse (TTR) were secondary endpoints.
Sixty-six patients, median age of 74 years [30-95], were included, with 37.9% presenting MSI (n = 25). Organ invasion involved the last ileal loop (n = 17), another colonic segment (n = 15), omentum (n = 13), visceral peritoneum (n = 13), and the bladder (n = 4). Surgical quality criteria showed complete monobloc resection in all patients and 93.9% R0 resection. After a median follow-up of 5 years [3.5-6.6], the entire population showed a 5-year OS of 65.2% [53.0-80.3] and 5-year DFS of 53.5% [41.1-69.6], with 18.9% [6.8-29.4] experiencing relapses at 5 years. The MSI phenotype correlated with improved 5-year OS (75.5% [56.5-100] vs. 59.5% [44.9-79.0], HR 0.41 [0.17-0.99]; P = .04), but DFS and TTR did not differ. Adjuvant chemotherapy was administered to 34.9% of patients. Univariate analysis identified age > 65 years, MSI status, and the number of nodes as factors associated with OS.
These data underline, in relation to a low rate of relapse, the lack of consensus regarding the appropriate indication for adjuvant chemotherapy in this high-risk stage II population.
II 期结肠癌（CC）表现出相当大的预后异质性。我们的目的是评估生存情况，以及微卫星不稳定性（MSI）对 IIIC 期（T4bN0M0）CC 患者的预后影响。
我们进行了一项回顾性观察研究，纳入了 2010 年至 2020 年间在 2 个专家中心接受原发性 IIIC 期 CC 切除术的所有患者。主要终点是总生存期（OS）和无病生存期（DFS）以及复发时间（TTR）为次要终点。
共纳入 66 例患者，中位年龄 74 岁[30-95]，其中 37.9%（n=25）存在 MSI。器官侵犯累及回肠末段（n=17）、另一段结肠（n=15）、大网膜（n=13）、内脏腹膜（n=13）和膀胱（n=4）。所有患者均行完全整块切除术，93.9%达到 R0 切除。中位随访 5 年[3.5-6.6]后，全人群 5 年 OS 为 65.2%[53.0-80.3]，5 年 DFS 为 53.5%[41.1-69.6]，5 年复发率为 18.9%[6.8-29.4]。MSI 表型与改善的 5 年 OS 相关（75.5%[56.5-100] vs. 59.5%[44.9-79.0]，HR 0.41[0.17-0.99]；P=0.04），但 DFS 和 TTR 无差异。34.9%的患者接受了辅助化疗。单因素分析发现年龄>65 岁、MSI 状态和淋巴结数量与 OS 相关。
这些数据表明，在复发率较低的情况下，对于高危 II 期人群，辅助化疗的适当适应证缺乏共识。
