重新审视 IIB/C 期和 IIIA 期结肠癌之间的生存悖论。

Revisiting the survival paradox between stage IIB/C and IIIA colon cancer.

机构信息

Department of General Surgery, Affiliated Changshu Hospital of Nantong University, Changshu, 215500, China.

Department of General Surgery, Changshu No.5 People's Hospital, No. 289, Zhujiang Road, Changshu, 215500, Jiangsu, China.

出版信息

Sci Rep. 2024 Sep 27;14(1):22133. doi: 10.1038/s41598-024-73496-4.

Abstract

Patients with stage IIB/C (T4a-bN0) colon cancer often exhibit worse survival rates compared to those with stage IIIA (T1-2N1, T1N2a) colon cancer. This study re-evaluates the survival paradox using the latest Surveillance, Epidemiology, and End Results (SEER) data (released on April 17, 2024) to inform potential revisions to the staging criteria. Utilizing SEER data with 8th edition TNM staging criteria, 4692 colon cancer patients diagnosed between 2018 and 2021 were analyzed with chi-square test. Cox regression and Kaplan-Meier survival analysis were employed to assess factors associated with cancer-specific survival (CSS) and overall survival (OS). The 3-year CSS rates for stage IIB and IIC were 73.1% and 70.3%, respectively, whereas stage IIIA had a substantially higher CSS rate of 91% (P < 0.001). Similarly, the OS rates were 64.9% and 63.0% for stage IIB and IIC, respectively, compared to 83.1% for stage IIIA (P < 0.001). Multivariate analyses revealed stage IIIA patients had significantly lower risks of cancer-specific mortality (hazard ratio (HR) = 0.374, 95% CI: 0.296-0.473, P < 0.001) and overall mortality (HR = 0.575, 95% CI: 0.483-0.685, P < 0.001) compared to stage IIB patients. The upcoming 9th edition of the AJCC staging system should address this paradox by integrating advanced diagnostic markers and emphasizing the aggressive biology of T4 tumor, providing more accurate prognostic information and guiding more effective treatment strategies for colon cancer patients.

摘要

与 IIIA 期(T1-2N1、T1N2a)结肠癌患者相比,IIB/C 期(T4a-bN0)结肠癌患者的生存率往往更差。本研究利用最新的监测、流行病学和最终结果(SEER)数据(于 2024 年 4 月 17 日发布)重新评估了这一生存悖论,以提供潜在的分期标准修订信息。本研究使用 SEER 数据和第 8 版 TNM 分期标准,分析了 2018 年至 2021 年间诊断的 4692 例结肠癌患者,采用卡方检验。Cox 回归和 Kaplan-Meier 生存分析用于评估与癌症特异性生存(CSS)和总生存(OS)相关的因素。IIB 期和 IIC 期的 3 年 CSS 率分别为 73.1%和 70.3%,而 IIIA 期的 CSS 率显著更高,为 91%(P<0.001)。同样,IIB 期和 IIC 期的 OS 率分别为 64.9%和 63.0%,而 IIIA 期的 OS 率为 83.1%(P<0.001)。多变量分析显示,III 期患者癌症特异性死亡风险显著降低(风险比(HR)=0.374,95%可信区间:0.296-0.473,P<0.001),总死亡率风险也显著降低(HR=0.575,95%可信区间:0.483-0.685,P<0.001),与 IIB 期患者相比。即将发布的第 9 版 AJCC 分期系统应通过整合先进的诊断标志物并强调 T4 肿瘤的侵袭性生物学来解决这一悖论,为结肠癌患者提供更准确的预后信息并指导更有效的治疗策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e5ac/11436827/af5183a9645f/41598_2024_73496_Fig1_HTML.jpg

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