PDF(Pubmed)
Abstract：
Background: The impact of tumor size on the survival and chemotherapy reponse of early-stage colon cancer remains unclear. Our study explored the effect of tumor size on overall survival (OS) and postoperative chemotherapy efficacy in patients with stage I/II colon cancer. Methods: Stage I/II colon cancer patients from the Surveillance, Epidemiology and End Results (SEER) database and a China center were extracted as two cohorts respectively. X-tile program was adopted to acquire optimal cutoff points of tumor size (16mm and 49mm). Harrell\'s concordance index (c-index) and time-dependent receiver operating characteristic curve (ROC) were used to indicate discrimination ability of prognostic factors. Results: Overall, 104,908 and 168 stage I/II postoperative colon cancer patients from SEER database and a China center were eligible, respectively. Kaplan-Meier analysis showed that large tumor size was associated with poor OS in two cohorts. The effect of tumor size on OS gradually decreased as the T stage increased both before PSM (c-index 0.535 for T1N0M0 and 0.506 for T4N0M0, p<0.05) and after PSM (c-index 0.543 for T1N0M0, p<0.05; c-index 0.543 for T4N0M0, p>0.05). Stratified analyses showed that chemotherapy improved the OS rate by 9.5% (chemotherapy vs. non-chemotherapy: 83.5% vs. 73.0%) or 12.8% (chemotherapy vs. non-chemotherapy: 85.7% vs. 72.9%) before and after PSM in T2N0M0 patients with tumor size >49 mm, but not in T1N0M0. The survival benefit provided by chemotherapy for T2N0M0 patients with large tumor was also validated in the Chinese cohort. Conclusions: Large tumor size was a risk factor for stage I/II colon cancer, especially for T1N0M0. Tumor size could serve as a complementary factor guiding postoperative chemotherapy for T2N0M0 patients.
摘要：
背景：肿瘤大小对早期结肠癌的生存和化疗反应的影响尚不清楚。我们的研究探讨了肿瘤大小对I/II期结肠癌患者总生存期（OS）和术后化疗疗效的影响。方法：I/II期结肠癌患者的监测，流行病学和最终结果（SEER）数据库和中国中心分别被提取为两个队列。采用X-tile程序获取肿瘤大小（16mm和49mm）的最佳截止点。使用Harrell一致性指数（c指数）和时间依赖性受试者工作特征曲线（ROC）来指示预后因素的辨别能力。结果：总体而言，来自SEER数据库和中国中心的104,908和168例I/II期术后结肠癌患者符合条件，分别。Kaplan-Meier分析显示，在两个队列中，大肿瘤大小与不良OS相关。在PSM之前（T1N0M0的c指数0.535和T4N0M0的0.506，p<0.05）和PSM之后（T1N0M0的c指数0.543，p<0.05；T4N0M0的c指数0.543，p>0.05），随着T分期的增加，肿瘤大小对OS的影响逐渐降低。分层分析表明，化疗使OS率提高了9.5%(化疗与非化疗：83.5%vs.73.0%）或12.8%（化疗与非化疗：85.7%vs.72.9％）在T2N0M0患者中，肿瘤大小>49mm的PSM前后，但不是在T1N0M0中。化疗为T2N0M0大肿瘤患者提供的生存益处也在中国队列中得到验证。结论：大肿瘤大小是I/II期结肠癌的危险因素，尤其是T1N0M0。肿瘤大小可作为指导T2N0M0患者术后化疗的补充因素。
