Stephens Kyle R, Donica Walter R F, Egger Michael E, Philips Prejesh, Scoggins Charles R, McMasters Kelly M, Martin Robert C G
Department of Surgery, Division of Surgical Oncology, University of Louisville School of Medicine, Louisville, KY, USA.
Ann Surg Oncol. 2025 Jan;32(1):418-423. doi: 10.1245/s10434-024-16330-5. Epub 2024 Oct 8.
The University of Louisville has observed a near 70% drop in resectable/borderline resectable metastatic colorectal cancer in the past 5 years. The aim of this study was to evaluate the distribution of colon cancer metastasis at diagnosis and at recurrence.
Stage was defined by the American joint committee on cancer (AJCC) eighth edition. Institutional review board approval was granted for post hoc review of stage II and III patients with colon cancer from the University of Louisville prospective hepatic database from 2002 to 2023, as well as for the National cancer database (NCDB) Participant user file (PUF) 2021. The Surveillance epidemiology and end-results (SEER) 22 database was also utilized to corroborate the findings in the NCDB.
Between 2018 and 2021 pathological M1a decreased annually (51.9-46.3%), while M1c increased year-over-year (26.6-32.4%) and M1b stayed relatively the same (21.4-21.3%). These differences were significant on chi-squared analysis with a p value of < 0.001. Univariate analysis of the post hoc review between 2017 and 2020 revealed significant differences between stage 4a and 4c in terms of race (p value 0.018), carcinoembryonic antigen (CEA) at diagnosis (p value 0.037), CEA at recurrence (p value 0.012), presence of liver metastasis (p value 0.003), and referral pattern (p value 0.014). Multivariate analysis identified stage 4b as an independent predictor for hepatic metastasis (odds ratio; OR 4.69, p value 0.011).
A significant change in the distribution of colon cancer metastases has occurred at an institutional and national level over the past 3-5 years. Interdisciplinary treatment strategies will have to be modified accordingly.
路易斯维尔大学观察到，在过去5年中，可切除/边界可切除的转移性结直肠癌患者数量下降了近70%。本研究的目的是评估结肠癌转移在诊断时和复发时的分布情况。
分期依据美国癌症联合委员会（AJCC）第八版。机构审查委员会批准对2002年至2023年路易斯维尔大学前瞻性肝脏数据库中的II期和III期结肠癌患者进行事后审查，以及对2021年国家癌症数据库（NCDB）参与者用户文件（PUF）进行审查。还利用监测、流行病学和最终结果（SEER）22数据库来证实NCDB中的研究结果。
2018年至2021年期间，病理M1a每年下降（51.9 - 46.3%），而M1c逐年增加（26.6 - 32.4%），M1b相对保持不变（21.4 - 21.3%）。经卡方分析，这些差异具有显著性，p值<0.001。对2017年至2020年事后审查的单因素分析显示，4a期和4c期在种族（p值0.018）、诊断时的癌胚抗原（CEA）（p值0.037）、复发时的CEA（p值0.012）、肝转移的存在（p值0.003）和转诊模式（p值0.014）方面存在显著差异。多因素分析确定4b期是肝转移的独立预测因素（比值比；OR 4.69，p值0.011）。
在过去3至5年中，机构和国家层面的结肠癌转移分布发生了显著变化。跨学科治疗策略必须相应调整。
