Clinical impact of tumor location on the colon cancer survival and recurrence: analyses of pooled data from three large phase III randomized clinical trials.
Clinical impact of tumor location on the colon cancer survival and recurrence: analyses of pooled data from three large phase III randomized clinical trials.
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DOI：
10.1002/cam4.1208
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发表时间：
2017-11
期刊：
影响因子：
4
通讯作者：
Yoshikawa T
中科院分区：
文献类型：
--
作者：
Aoyama T;Kashiwabara K;Oba K;Honda M;Sadahiro S;Hamada C;Maeda H;Mayanagi S;Kanda M;Sakamoto J;Saji S;Yoshikawa T
本研究的目的是通过对日本进行的三项大型III期研究的综合分析，确定结肠癌根治性切除患者的总生存期(OS)和无病生存期(DFS)是否受肿瘤部位的影响。本研究共纳入4029名患者。如果原发灶位于盲肠、升结肠、肝曲或横结肠，则为右侧结肠癌(RC)；如果肿瘤位于脾曲、降结肠、乙状结肠或直肠乙状结肠交界处，则为左侧结肠癌(LCC)。分析了OS和DFS的风险因素。在本研究中，1449名患者为RC，2580名患者为LCC。术后3年和5年，RC组OS率分别为87.6%和81.6%，LCC组分别为91.5%和84.5%。单因素和多因素分析显示，RRC使死亡风险增加了19.7%(调整后的危险比为1.197；95%可信区间为1.020-1.408；P=0.0272)。相比之下，这两个地点的DFS相似。本研究证实肿瘤部位是结肠癌根治性治疗患者OS的危险因素。因此，在未来的结肠癌III期试验中，肿瘤的位置可能需要被考虑为分层因素。
The aim of the present study was to determine whether or not the overall survival (OS) and disease‐free survival (DFS) were affected by the tumor location in patients who underwent curative resection for colon cancer in a pooled analysis of three large phase III studies performed in Japan. In total, 4029 patients were included in the present study. Patients were classified as having right‐side colon cancer (RC) if the primary tumor was located in the cecum, ascending colon, hepatic flexure or transverse colon, and left‐side colon cancer (LCC) if the tumor site was within the splenic flexure, descending colon, sigmoid colon or recto sigmoid junction. The risk factors for the OS and DFS were analyzed. In the present study, 1449 patients were RC, and 2580 were LCC. The OS rates at 3 and 5 years after surgery were 87.6% and 81.6% in the RC group and 91.5% and 84.5% in the LCC group, respectively. Uni‐ and multivariate analyses showed that RRC increased the risk of death by 19.7% (adjusted hazard ratio = 1.197; 95% confidence interval, 1.020–1.408; P = 0.0272). In contrast, the DFS was similar between the two locations. The present study confirmed that the tumor location was a risk factor for the OS in patients who underwent curative treatment for colon cancer. Tumor location may, therefore, need to be considered a stratification factor in future phase III trials of colon cancer.
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