pT1-3 期和结肠旁淋巴结侵犯的结直肠癌的生存分析：阳性结肠旁淋巴结比率对辅助化疗的预后作用。

Survival analysis in pT1-3 and paracolic lymph-node invasion colorectal cancer: the prognostic role of positive paracolic lymph-node ratio for adjuvant chemotherapy.

机构信息

Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.

The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangdong, 510405, China.

出版信息

Clin Transl Oncol. 2024 Dec;26(12):2993-3002. doi: 10.1007/s12094-024-03470-z. Epub 2024 May 23.

DOI:10.1007/s12094-024-03470-z

PMID:38782864

Abstract

PURPOSE

Several studies have observed that some stage III colorectal cancer (CRC) patients cannot benefit from standard adjuvant chemotherapy. However, there is no unified screening standard to date.

METHODS

Consecutive patients with pathologically confirmed colon adenocarcinoma treated in 3 centers between January 2016 and December 2018 were included. Patients were divided into four groups according to different stages and positive paracolic lymph-node ratio (P-LNR) [Cohort 1: pT1-3N0M0, Cohort 2: pT1-3N + (P-LNR ≤ 0.15)M0, Cohort 3: pT4N0M0, Cohort 4: stage III patients except for pT1-3N + (P-LNR ≤ 0.15)M0], and further overall survival was compared by Kaplan-Meier method. The univariate and multivariate analyses were employed for cox proportional hazards model.

RESULTS

We retrospectively reviewed 5581 consecutive CRC patients with, and 2861 eligible patients were enrolled for further analysis. The optimal cut-off value of P-LNR in our study was 0.15. There was no significant difference in OS (91.36 vs. 93.74%) and DFS (87.65 vs. 90.96%) between stage III patients with pT1-3N + (P-LNR ≤ 0.15)M0 and those with pT1-3N0M0. Further analysis demonstrated that CRC patients with pT1-3N + (P-LNR ≤ 0.15)M0 were less likely to benefit from 8 cycles of CAPOX or FOLFOX chemotherapy and suffered fewer adverse events from declining chemotherapy. Comparing with 0-4 cycles versus 8 cycles, the overall survival rates were 91.35 versus 90.19% (P = 0.79), and with a DFS of 87.50 versus 88.24% (P = 0.49), the duration of adjuvant chemotherapy was not an independent risk factor for patients with pT1-3N + (P-LNR ≤ 0.15)M0 (HR: 0.70, 95% CI 0.90-1.30, P = 0.42).

CONCLUSION

The concept of P-LNR we proposed might have a high clinical application value and accurately enable clinicians to screen out specific CRC patients who decline or prefer limited chemotherapy.

TRIAL REGISTRY

The clinical trial registration number: ChiCTR2300076883.

摘要

目的

几项研究表明，一些 III 期结直肠癌（CRC）患者不能从标准辅助化疗中获益。然而，目前尚无统一的筛选标准。

方法

连续纳入 2016 年 1 月至 2018 年 12 月在 3 个中心接受治疗的经病理证实的结肠腺癌患者。根据不同的分期和阳性结肠旁淋巴结比（P-LNR），患者被分为 4 组[队列 1：pT1-3N0M0，队列 2：pT1-3N+（P-LNR≤0.15）M0，队列 3：pT4N0M0，队列 4：除 pT1-3N+（P-LNR≤0.15）M0 以外的 III 期患者]，并采用 Kaplan-Meier 方法比较总生存期。采用单因素和多因素分析 cox 比例风险模型。

结果

我们回顾性分析了 5581 例连续 CRC 患者，其中 2861 例符合条件的患者被纳入进一步分析。本研究中 P-LNR 的最佳截断值为 0.15。pT1-3N+（P-LNR≤0.15）M0 与 pT1-3N0M0 期 III 期患者的 OS（91.36% vs. 93.74%）和 DFS（87.65% vs. 90.96%）无显著差异。进一步分析表明，pT1-3N+（P-LNR≤0.15）M0 的 CRC 患者不太可能从 8 个周期的 CAPOX 或 FOLFOX 化疗中获益，并且减少化疗导致的不良事件更少。与 0-4 个周期与 8 个周期相比，总生存率分别为 91.35%与 90.19%（P=0.79），DFS 分别为 87.50%与 88.24%（P=0.49），辅助化疗持续时间不是 pT1-3N+（P-LNR≤0.15）M0 患者的独立危险因素（HR：0.70，95%CI 0.90-1.30，P=0.42）。