I期结肠癌根治性手术后复发的预测因素：意大利外科肿瘤学会结直肠癌网络协作组的回顾性队列分析

Predictors of Recurrence After Curative Surgery for Stage I Colon Cancer: Retrospective Cohort Analysis of the Italian Society of Surgical Oncology Colorectal Cancer Network Collaborative Group.

作者信息

Turri Giulia, Martinelli Luigi, Rega Daniela, Tamini Nicolò, Paiano Lucia, Deidda Simona, Bao QuocRiccardo, Lorenzon Laura, De Luca Raffaele, Foppa Caterina, Mari Valentina, Taffurelli Giovanni, Picciariello Arcangelo, Marsanic Patrizia, Siragusa Leandro, Bagolini Francesco, Nascimbeni Riccardo, Rizzo Gianluca, Vertaldi Sara, Zuolo Michele, Bianchi Giorgio, Rorato Lisa Marie, Reddavid Rossella, Gallo Gaetano, Crepaz Lorenzo, Di Leo Alberto, Trompetto Mario, Potenza Enrico, Santarelli Mauro, de'Angelis Nicola, Ciarleglio Francesco, Milone Marco, Coco Claudio, Tiberio Guido Alberto, Anania Gabriele, Sica Giuseppe S, Muratore Andrea, Altomare Donato Francesco, Montroni Isacco, De Luca Maurizio, Spinelli Antonino, Simone Michele, Persiani Roberto, Spolverato Gaya, Restivo Angelo, de Manzini Nicolò, Braga Marco, Delrio Paolo, Verlato Giuseppe, Pedrazzani Corrado

机构信息

From the Chirurgia Generale ed Epatobiliare, Azienda Ospedaliera Universitaria Integrata di Verona, Università degli Studi di Verona, Verona, Italy.

Department of Diagnostic and Public Health, University of Verona, Verona, Italy.

出版信息

Ann Surg Open. 2024 Nov 18;5(4):e510. doi: 10.1097/AS9.0000000000000510. eCollection 2024 Dec.

DOI:10.1097/AS9.0000000000000510

PMID:39711675

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11661724/

Abstract

OBJECTIVE

The aim of this study is to provide solid evidence to update the management of stage I colon cancer (CC) after surgery.

BACKGROUND

Given the low risk of recurrence of stage I CC, some international guidelines do not recommend intensive follow-up after surgery. However, data on the actual incidence, risk factors, and site of recurrences are scarce.

METHODS

This is a retrospective multicenter cohort study considering patients who underwent surgery at 25 Italian centers between 2010 and 2019, with a minimum follow-up of 24 months. A total of 1883 consecutive adult patients with stage I CC treated with curative surgery were considered, and 1611 fulfilled the inclusion criteria. The primary outcome was the rate of recurrence. Secondary outcomes included survival and risk factors for recurrence.

RESULTS

Eighty patients developed cancer recurrence (5.0%), of which 90% was systemic relapse. The event was more frequent in pT2 (6.0% vs 3.2%, = 0.013), male patients (6.1% vs 3.6%, = 0.021), in the presence of lymphovascular invasion (7.2% vs 3.6%, = 0.01), and in cases of partial resection (11.1% vs 4.6%, = 0.011). Also, preoperative carcinoembryonic antigen ( = 0.007) and tumor diameter ( < 0.001) were higher in the group who relapsed. Most patients had isolated cancer recurrence (90%). Recurrences peaked between 10 and 18 months after surgery and declined over time. Adjusted Cox regression analysis identified tumor diameter, carcinoembryonic antigen level, lymphovascular invasion, male gender, and less than 12 analyzed lymph nodes as significant risk factors for worse recurrence-free survival.

CONCLUSIONS

This study showed that a not negligible rate of stage I CC recur after curative surgery. Most relapses occur at a single site within the first 3 years after surgery. This evidence could be used to optimize postoperative follow-up.

摘要

目的

本研究旨在提供确凿证据，以更新I期结肠癌（CC）术后的管理方案。

背景

鉴于I期CC复发风险较低，一些国际指南不建议术后进行强化随访。然而，关于实际复发率、危险因素及复发部位的数据却很匮乏。

方法

这是一项回顾性多中心队列研究，纳入了2010年至2019年间在25个意大利中心接受手术的患者，且随访时间至少为24个月。共纳入1883例接受根治性手术治疗的I期CC成年患者，其中1611例符合纳入标准。主要结局为复发率。次要结局包括生存率及复发危险因素。

结果

80例患者出现癌症复发（5.0%），其中90%为全身复发。该事件在pT2期（6.0%对3.2%，P = 0.013）、男性患者（6.1%对3.6%，P = 0.021）、存在淋巴管侵犯（7.2%对3.6%，P = 0.01）以及部分切除病例（11.1%对4.6%，P = 0.011）中更为常见。此外，复发组患者术前癌胚抗原水平（P = 0.007）和肿瘤直径（P < 0.001）更高。大多数患者为孤立性癌症复发（90%）。复发高峰出现在术后10至18个月之间，并随时间下降。校正后的Cox回归分析确定肿瘤直径、癌胚抗原水平、淋巴管侵犯、男性性别以及分析的淋巴结少于12个是无复发生存较差的显著危险因素。