Cascinu S, Ligi M, Graziano F, Del Ferro E, Valentini M, Grianti C, Bartolucci M, Catalano G
Sezione di Oncologia Sperimentale, Unità Operativa di Oncologia Medica, Pesaro, Italy.
Cancer. 1998 Sep 15;83(6):1081-5.
Adjuvant chemotherapy for colorectal carcinoma was found to improve survival of patients with American Joint Committee on Cancer/International Union Against Cancer Stage III disease. The usefulness of chemotherapy in patients with Stage II disease continues to be debated, and it is likely that only those patients with a poor prognosis should receive adjuvant chemotherapy. Biologic prognostic factors may allow further insight into the optimal treatment strategy for patients with Stage II or earlier disease. In this study the prognostic role of S-phase fraction (SPF) determined by flow cytometry was assessed in patients with Stage I-II colorectal carcinoma.
Specimens of surgically resected colorectal carcinoma were examined for SPF by flow cytometric DNA analysis. Consecutive patients referred to the study institution were considered eligible for this study. The main inclusion criteria were a Stage I-II tumor together with sufficient tumor material and adequate follow-up information. For each stage of disease, SPF data were associated with the recurrence rate and the disease free survival (DFS).
Analysis was performed on 167 patients (65 with Stage I disease and 102 with Stage II disease). Among Stage I patients, SPF was high in 20 patients and low in 45 patients. In Stage II patients, there were 36 patients with low SPF and 66 patients with high SPF. In both stages, the recurrence rate and DFS were significantly worse for the subgroups of patients with high SPF.
SPF has revealed prognostic differences among patients with surgically resected Stage I-II colorectal carcinoma. These data should be considered for planning future trials in the adjuvant setting because patients with high SPF may benefit from adjuvant chemotherapy.
研究发现，辅助化疗可提高美国癌症联合委员会/国际抗癌联盟III期结直肠癌患者的生存率。II期疾病患者化疗的有效性仍存在争议，可能只有那些预后较差的患者才应接受辅助化疗。生物学预后因素可能有助于进一步了解II期或更早疾病患者的最佳治疗策略。在本研究中，评估了通过流式细胞术测定的S期细胞分数（SPF）在I-II期结直肠癌患者中的预后作用。
通过流式细胞术DNA分析检查手术切除的结直肠癌标本的SPF。转诊至研究机构的连续患者被认为符合本研究条件。主要纳入标准为I-II期肿瘤，同时有足够的肿瘤组织和充分的随访信息。对于每个疾病阶段，将SPF数据与复发率和无病生存期（DFS）相关联。
对167例患者进行了分析（65例I期疾病患者和102例II期疾病患者）。在I期患者中，20例患者的SPF较高，45例患者的SPF较低。在II期患者中，36例患者的SPF较低，66例患者的SPF较高。在两个阶段中，SPF较高的患者亚组的复发率和DFS均明显较差。
SPF揭示了手术切除的I-II期结直肠癌患者之间的预后差异。在规划未来的辅助治疗试验时应考虑这些数据，因为SPF较高的患者可能从辅助化疗中获益。
