DNA倍体、基质和核型分析相结合预测III期结肠癌预后并调整辅助化疗疗程

Combination of DNA ploidy, stroma, and nucleotyping predicting prognosis and tailoring adjuvant chemotherapy duration in stage III colon cancer.

作者信息

Peng Jianhong, Zhang Weili, He Jiahua, Wang Weifeng, Li Weihao, Mao Lijun, Dong Yuejin, Lu Zhenhai, Pan Zhizhong, Zhou Chi, Wu Xiaojun

机构信息

Department of Colorectal Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Guangzhou, Guangdong, P.R. China.

My-BioMed Technology (Guangzhou) Co., Ltd, Guangzhou, Guangdong, P.R. China.

出版信息

Ther Adv Med Oncol. 2024 Jun 16;16:17588359241260575. doi: 10.1177/17588359241260575. eCollection 2024.

DOI:10.1177/17588359241260575

PMID:38894737

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11185039/

Abstract

INTRODUCTION

DNA ploidy (P), stroma fraction (S), and nucleotyping (N) collectively known as PSN, have proven prognostic accuracy in stage II colorectal cancer (CRC). However, few studies have reported on the prognostic value of the PSN panel in stage III colon cancer patients receiving capecitabine and oxaliplatin adjuvant chemotherapy.

OBJECTIVES

This study aimed to validate PSN's prognostic impact on stage III colon cancer, identifying candidates for optimized adjuvant chemotherapy duration.

DESIGN

A retrospective analysis was conducted on a cohort of stage III colon cancer patients from April 2008 to June 2020.

METHODS

Postoperative pathological samples from stage III colon cancer patients who underwent radical surgery and postoperative adjuvant chemotherapy at Sun Yat-sen University Cancer Center were retrospectively collected. Automated digital imaging assessed PSN, categorizing risk groups. Kaplan-Meier, Cox regression, and time-dependent receiver operating characteristic analysis compared model validity.

RESULTS

Significant differences in 5-year disease-free survival (DFS) and overall survival (OS) were noted among PSN-based low-, moderate-, and high-risk groups (DFS: 92.10% 83.62% 79.80%, = 0.029; OS: 96.69% 93.99% 90.12%, = 0.016). PSN emerged as an independent prognostic factor for DFS [hazard ratio (HR) = 1.409, 95% confidence interval (CI): 1.002-1.981, = 0.049] and OS (HR = 1.720, 95% CI: 1.127-2.624, = 0.012). The PSN model, incorporating perineural invasion and tumor location, displayed superior area under the curve for 5-year (0.692 0.553, = 0.020) and 10-year (0.694 0.532, = 0.006) DFS than TNM stage. In the PSN high-risk group, completing eight cycles of adjuvant chemotherapy significantly improved 5-year DFS and OS compared to four to seven cycles (DFS: 89.43% 71.52%, = 0.026; OS: 96.77% 85.46%, = 0.007).

CONCLUSION

The PSN panel effectively stratifies stage III colon cancer, aiding in optimized adjuvant chemotherapy duration determination.

摘要

引言

DNA倍体（P）、基质分数（S）和核型分析（N）统称为PSN，已被证明在II期结直肠癌（CRC）中具有预后准确性。然而，很少有研究报道PSN指标在接受卡培他滨和奥沙利铂辅助化疗的III期结肠癌患者中的预后价值。

目的

本研究旨在验证PSN对III期结肠癌的预后影响，确定优化辅助化疗疗程的候选对象。

设计

对2008年4月至2020年6月期间的一组III期结肠癌患者进行回顾性分析。

方法

回顾性收集在中山大学肿瘤防治中心接受根治性手术和术后辅助化疗的III期结肠癌患者的术后病理样本。通过自动数字成像评估PSN，对风险组进行分类。采用Kaplan-Meier法、Cox回归法和时间依赖性受试者工作特征分析来比较模型的有效性。

结果

基于PSN的低、中、高风险组在5年无病生存期（DFS）和总生存期（OS）方面存在显著差异（DFS：92.10%、83.62%、79.80%，P = 0.029；OS：96.69%、93.99%、90.12%，P = 0.016）。PSN成为DFS的独立预后因素[风险比（HR）= 1.409，95%置信区间（CI）：1.002 - 1.981，P = 0.049]和OS的独立预后因素（HR = 1.720，95%CI：1.127 - 2.624，P = 0.012）。结合神经周围侵犯和肿瘤位置的PSN模型在5年（0.692对0.553，P = 0.020）和10年（0.694对0.532，P = 0.006）DFS方面显示出比TNM分期更高的曲线下面积。在PSN高风险组中，与4至7个周期相比，完成8个周期的辅助化疗显著改善了5年DFS和OS（DFS：89.43%对71.52%，P = 0.026；OS：96.77%对85.46%，P = 0.007）。