Distinct Prognosis of High Versus Mid/Low Rectal Cancer: a Propensity Score-Matched Cohort Study
Distinct Prognosis of High Versus Mid/Low Rectal Cancer: a Propensity Score-Matched Cohort Study
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DOI：
10.1007/s11605-018-04072-1
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发表时间：
2019-07-01
影响因子：
3.2
通讯作者：
Chen, Chuang-Qi
中科院分区：
文献类型：
--
作者：
Cheng, Lv-Jia;Chen, Jian-Hui;Chen, Chuang-Qi
背景直肠癌长期以来被作为单一实体疾病治疗;但是，在此情况下，高位直肠癌的预后是否（下缘距肛缘10.1 ~ 15.0cm）与中低位直肠癌不同方法I-III期直肠腺癌患者行根治性切除术，在这项回顾性分析中，2007年至2013年期间入组了意向手术。排除标准为新辅助治疗或并发癌症。倾向评分匹配和考克斯回归分析进行比较高和中/低直肠癌患者之间的5年总体和癌症特异性生存率。结果符合纳入标准的613例患者中，199例（32.5%）和414例（67.5%）分别有高和中/低直肠癌。在倾向评分匹配后（每组187例），与III期疾病的中/低组相比，高组显示出更好的5年总生存率（70.9 vs. 56.9%，p=0.042）和癌症特异性生存率（77.4 vs. 60.3%，p=0.028）。然而，在I-II期疾病中，高位直肠癌并没有表现出预后优势。多变量分析确定高肿瘤位置是癌症特异性生存的独立预后因素（风险比=0.422，95%置信区间0.226-0.786，p=0.007）和总生存期（风险比=0.613，95%置信区间0.379-0.991，P=0.046）.结论III期高位直肠腺癌患者的总体生存率和肿瘤特异性生存率优于中/低位直肠腺癌患者，肿瘤部位是直肠癌患者的独立预后因素。
BackgroundRectal cancers have long been treated as a single-entity disease; however, whether the prognosis of high rectal cancer (inferior margin located 10.1 to 15.0cm from the anal verge) differs from that of mid/low rectal cancer (0 to 10.0cm) remains disputed.MethodsPatients with stages I-III rectal adenocarcinomas undergoing curative-intent surgery were enrolled between 2007 and 2013 in this retrospective analysis. Exclusion criteria were neoadjuvant therapy or concurrent cancers. Propensity score matching and Cox regression analysis were performed to compare a 5-year overall and cancer-specific survival between patients with high and mid/low rectal cancer.ResultsOf 613 patients who met the inclusion criteria, 199 (32.5%) and 414 (67.5%) had high and mid/low rectal cancer, respectively. After propensity score matching (187 cases for each group), the high group showed a better overall survival (70.9 vs. 56.9%, p=0.042) and cancer-specific survival (77.4 vs. 60.3%, p=0.028) at 5years compared with the mid/low group with stage III disease. However, high rectal cancer did not demonstrate prognostic superiority in stages I-II disease. Multivariate analysis identified high tumor location as an independent prognostic factor for cancer-specific survival (hazards ratio=0.422, 95% confidence interval 0.226-0.786, p=0.007) and overall survival (hazards ratio=0.613, 95% confidence interval 0.379-0.991, p=0.046).ConclusionsPatients with stage III high rectal adenocarcinoma demonstrated better overall and cancer-specific survival than those with mid/low type, and tumor location was an independent prognostic factor for patients with rectal carcinomas.