目的:副作用已成为现代系统疗法治疗转移性结直肠癌的预后因素。这项研究调查了它是否也与包括所有阶段的未选择患者队列相关。
方法:所有1995年至2018年期间收治的结肠癌患者均从机构持有的数据库中检索。将患者分为两组。第一个队列包括没有远处转移的患者,他们能够进行治愈性切除。第二组出现远处转移(IV期)。对可能的预后因素进行多变量Cox回归分析。
结果:总体而言,1,606例患者符合纳入和排除标准。在没有远处转移的1,222例患者中实现了R0切除。该组的五年病因特异性生存率为89.3%。右侧和左侧癌症之间没有差异(88.2%与90.1%,p=0.220)。然而,盲肠癌的预后明显差于所有其他部位(83.5%vs.90.2%,p=0.007)。在多变量分析中,pT类,pN-category,分级,血管浸润,紧急操作,辅助化疗,盲肠癌仍然是独立的预后因素。在384名IV期患者中,正确的3年总生存率与左侧癌症仅在单变量分析中有所不同(17.7%与28.6%,p=0.013)。
结论:在非转移性结肠癌中,盲肠的位置是一个独立的预后因素。在未经选择的IV期结肠癌患者中,没有发现片面性是预后因素。区分为右侧和左侧肿瘤可能很简单,有必要对不同结肠部位的生物学行为进行进一步研究。
OBJECTIVE: Sidedness has emerged as a prognostic factor for metastatic colorectal cancer treated with modern systemic therapies. This study investigates whether it is also relevant for an unselected patient cohort including all stages.
METHODS: All consecutive patients admitted with colon cancer between 1995 and 2018 were retrieved from an institution-held database. Patients were divided into two cohorts. The first cohort included patients without distant metastases who were able to undergo curative resection. The second cohort presented with distant metastases (stage IV). Potentially prognostic factors were subjected to multivariate Cox Regression analysis.
RESULTS: Overall, 1,606 patients met the inclusion and exclusion criteria. An R0-resection was achieved in 1,222 patients without distant metastases. Five-year cause-specific survival rate was 89.3% for this group. There was no difference between right- and left-sided cancers (88.2% vs. 90.1%, p = 0.220). However, prognosis of caecal carcinoma was significantly worse than that of all other sites combined (83.5% vs. 90.2%, p = 0.007). In multivariate analysis, pT-category, pN-category, grading, vascular invasion, emergency operation, adjuvant chemotherapy, and caecal carcinoma remained as independent prognostic factors. In the 384 patients with stage IV-disease, 3-year overall survival for right- vs. left-sided cancers differed only in univariate analysis (17.7% vs. 28.6%, p = 0.013).
CONCLUSIONS: In non-metastatic colon cancer, location in the caecum is an independent prognostic factor. In unselected patients with stage IV colon cancer, sidedness was not found to be a prognostic factor. Differentiation into right- and left-sided tumors may be simplistic, and further studies on the biological behavior of different colonic sites are warranted.