Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
Division of Colorectal Surgery, Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan.
Int J Colorectal Dis. 2024 Oct 14;39(1):161. doi: 10.1007/s00384-024-04737-1.
The survival rates of patients with stage IIB and IIC colon cancer are paradoxically inferior to that of patients with stage IIIA colon cancer. This study aimed to examine the oncological outcomes and investigate the factors that could affect the staging paradox among stage IIB, IIC, and IIIA colon cancers based on a 9-year cancer database.
Patients with stage IIB (pT4aN0M0), IIC (pT4bN0M0), or IIIA (pT1-2N1M0) colon cancer were retrospectively selected from a prospectively maintained medical database from January 2011 to December 2019. Factors that might influence the staging paradox, including radicality, harvested lymph nodes, and chemotherapy administration, were examined.
A total of 282 patients (stage IIB, n = 59; stage IIC, n = 46; and stage IIIA, n = 177) were enrolled. Patients with stage IIB/C cancer demonstrated higher carcinoembryonic antigen levels, larger tumor size, more frequent tumor obstruction, and higher locoregional recurrence than those with stage IIIA cancer. With respect to 10-year locoregional recurrence-free survival and cancer-specific survival, patients with stage IIB and IIC cancers had significantly lower survival rates than did those with stage IIIA cancer (73.7% vs. 66.3% vs. 91.2%, P = 0.0003; 5.4% vs. 10.9% vs. 11.2%, P = 0.0023). The staging paradox persisted in patients who underwent R0 resection, had harvested lymph nodes ≥ 12, and received chemotherapy, as confirmed by multivariate regression analysis.
Based on the inferior oncological outcomes and higher locoregional recurrence rate, this study highlighted the need for intensified cytotoxic chemotherapy specific to this recurrence pattern for patients with stage IIB/C colon cancer.
ⅡB 期和 IIC 期结肠癌患者的生存率与 IIIA 期结肠癌患者相比反而较差。本研究旨在基于 9 年癌症数据库，检查肿瘤学结果并探讨影响ⅡB、IIC 和 IIIA 期结肠癌分期悖论的因素。
从 2011 年 1 月至 2019 年 12 月的前瞻性维护的医学数据库中回顾性选择ⅡB 期（pT4aN0M0）、IIC 期（pT4bN0M0）或 IIIA 期（pT1-2N1M0）结肠癌患者。检查可能影响分期悖论的因素，包括根治性、采集的淋巴结和化疗的应用。
共纳入 282 例患者（ⅡB 期，n=59；IIC 期，n=46；IIIA 期，n=177）。ⅡB/C 期癌症患者的癌胚抗原水平更高、肿瘤更大、更频繁发生肿瘤阻塞，且局部区域复发率高于 IIIA 期癌症患者。在 10 年局部区域无复发生存率和癌症特异性生存率方面，ⅡB 和 IIC 期癌症患者的生存率明显低于 IIIA 期癌症患者（73.7% vs. 66.3% vs. 91.2%，P=0.0003；5.4% vs. 10.9% vs. 11.2%，P=0.0023）。多元回归分析证实，在接受 R0 切除、采集淋巴结≥12 个和接受化疗的患者中，这种分期悖论仍然存在。
根据较差的肿瘤学结果和更高的局部区域复发率，本研究强调需要针对这种复发模式为ⅡB/C 期结肠癌患者强化特定的细胞毒性化疗。
