Watson P, Lin K M, Rodriguez-Bigas M A, Smyrk T, Lemon S, Shashidharan M, Franklin B, Karr B, Thorson A, Lynch H T
Department of Preventive Medicine and Public Health, Creighton University School of Medicine, Omaha, Nebraska 68178, USA.
Cancer. 1998 Jul 15;83(2):259-66.
Patients with hereditary nonpolyposis colorectal carcinoma (HNPCC) reportedly have better prognoses than sporadic colorectal carcinoma (CRC) patients, but it has been unclear whether this could be due to differences in stage at diagnosis. The current study compared stage and survival in a retrospective cohort of HNPCC family members who developed CRC with the same factors in an unselected hospital series of patients with sporadic CRC.
This retrospective cohort study compared HNPCC cases (274 cases from 98 HNPCC families) with an unselected hospital series comprising 820 consecutive CRC cases. All patients were staged according to the TNM system of the American Joint Committee on Cancer and the International Union Against Cancer. Median follow-up among living patients was > 10 years and 8.5 years, respectively, for the two cohorts. Cox regression was used to compare survival in stage-stratified analyses of time from diagnosis to death.
Compared with the unselected series, the HNPCC cases had lower stage disease (P < 0.001), and fewer had distant metastases at diagnosis (P < 0.001 in an analysis stratified by T classification). In stage-stratified survival analysis, the HNPCC cases had a significant overall survival advantage regardless of adjustment for their younger age. A conservative estimate of the hazard ratio (of HNPCC cases to the unselected series) was 0.67 (P < 0.0012).
HNPCC patients had lower stage disease at diagnosis than the unselected CRC cases, mainly due to rarer distant metastases at diagnosis. They survived longer than unselected CRC patients with tumors of the same stage. The estimated death rate for the HNPCC cases, adjusted for stage and age differences, was at most two-thirds of the rate for the hospital series.
据报道，遗传性非息肉病性结直肠癌（HNPCC）患者的预后比散发性结直肠癌（CRC）患者更好，但尚不清楚这是否归因于诊断时分期的差异。本研究在一个回顾性队列中比较了发生CRC的HNPCC家族成员的分期和生存率，该队列中的这些成员与一个未经过挑选的散发性CRC患者医院系列中的患者在相同因素方面进行了对比。
这项回顾性队列研究将HNPCC病例（来自98个HNPCC家族的274例）与一个包含820例连续CRC病例的未经过挑选的医院系列进行了比较。所有患者均根据美国癌症联合委员会和国际抗癌联盟的TNM系统进行分期。两个队列中存活患者的中位随访时间分别>10年和8.5年。在从诊断到死亡时间的分期分层分析中，使用Cox回归比较生存率。
与未经过挑选的系列相比，HNPCC病例的疾病分期较低（P<0.001），诊断时发生远处转移的病例较少（按T分类分层分析中P<0.001）。在分期分层生存分析中，无论对其较年轻的年龄进行调整与否，HNPCC病例均具有显著的总生存优势。对风险比（HNPCC病例与未经过挑选的系列相比）的保守估计为0.67（P<0.0012）。
HNPCC患者诊断时的疾病分期低于未经过挑选的CRC病例，主要原因是诊断时远处转移较少见。他们比具有相同分期肿瘤的未经过挑选的CRC患者存活时间更长。经分期和年龄差异调整后，HNPCC病例的估计死亡率最多为医院系列死亡率的三分之二。
