Prognosis and value of adjuvant chemotherapy in stage III mucinous colorectal carcinoma
Prognosis and value of adjuvant chemotherapy in stage III mucinous colorectal carcinoma
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DOI：
10.1093/annonc/mdt378
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发表时间：
2013-11-01
影响因子：
50.5
通讯作者：
de Wilt, J. H. W.
中科院分区：
文献类型：
--
作者：
Hugen, N.;Verhoeven, R. H. A.;de Wilt, J. H. W.
与非粘液腺癌 (NMC) 相比，结直肠粘液腺癌 (MC) 与预后受损相关。转移性疾病对姑息化疗的反应较差，但辅助化疗的益处从未在大型患者群体中进行过评估。本研究分析了 MC 根治性切除后患者的总体生存率和辅助化疗的疗效。这项基于人群的研究涉及 27 251 名未经选择的 1990 年至 2010 年间诊断为结直肠癌的患者，并记录在基于前瞻性病理学的登记中。 Kaplan-Meier 分析和对数秩检验用于估计生存率。采用Cox比例风险模型计算死亡的多变量风险比。结直肠肿瘤中MC占12.3%（N = 3052），其分布与NMC不同，其中24.4%位于直肠，54.3%位于近端结肠（相对于38.0%和30.6%），P < 0.0001。 NMC 比 MC 更常被归类为 I 期疾病（20.5% vs 10.9%），P < 0.0001。调整协变量后，仅当位于直肠时 MC 才与较高的死亡风险相关[风险比 1.22； 95% 置信区间 (CI) 1.11-1.34]。多因素回归分析显示，III期MC和NMC患者辅助化疗后的生存率相似。MC的不良预后仅存在于直肠癌中。在辅助治疗中，MC和NMC的化疗疗效没有差异；因此，目前的辅助治疗建议不应考虑组织学。
Colorectal mucinous adenocarcinoma (MC) has been associated with impaired prognosis compared with nonmucinous adenocarcinoma (NMC). Response to palliative chemotherapy is poor in metastatic disease, but the benefit of adjuvant chemotherapeutic treatment has never been assessed in large patient groups. This study analyses overall survival and efficacy of adjuvant chemotherapy in terms of survival in patients following radical resection for MC.This population-based study involved 27 251 unselected patients diagnosed with colorectal carcinoma between 1990 and 2010 and recorded in a prospective pathology-based registry. Kaplan-Meier analysis and log-rank testing were used to estimate survival. Cox proportional hazard model was used to calculate multivariate hazard ratios for death.MC was found in 12.3% (N = 3052) of colorectal tumors with a different distribution compared with NMC, with 24.4% located in the rectum and 54.3% in the proximal colon (versus 38.0% and 30.6%), P < 0.0001. NMC was more often classified as stage I disease than MC (20.5% versus 10.9%), P < 0.0001. After adjustments for covariates, MC was associated with a higher risk of death only when located in the rectum [hazard ratio 1.22; 95% confidence interval (CI) 1.11-1.34]. Multivariate regression analysis showed a similar survival after adjuvant chemotherapy for stage III MC and NMC patients.The poor prognosis for MC is only present in rectal cancer. In the adjuvant setting, there is no difference in the efficacy of chemotherapy between MC and NMC; therefore, current adjuvant treatment recommendations should not take histology into account.