Obstruction predicts worse long-term outcomes in stage III colon cancer: A secondary analysis of the N0147 trial
Obstruction predicts worse long-term outcomes in stage III colon cancer: A secondary analysis of the N0147 trial
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DOI：
10.1016/j.surg.2018.06.044
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发表时间：
2018-12-01
期刊：
影响因子：
3.8
通讯作者：
Turaga, Kiran K.
中科院分区：
文献类型：
--
作者：
Dandaleh, Fadi S.;Sherman, Scott K.;Turaga, Kiran K.
背景：结肠癌患者经常出现梗阻。大型系列报道了高风险特征中的阻塞，但缺乏关于其具体预后影响的前瞻性数据。我们假设梗阻是 III 期结肠癌患者预后不良的独立危险因素。方法：N0147 是 2004 年至 2009 年间进行的一项试验，将 III 期结肠癌患者随机分配至亚叶酸（亚叶酸钙）、氟尿嘧啶和奥沙利铂辅助治疗方案，或联合或不联合西妥昔单抗。获得了仅接受化疗对照组的患者水平数据。提取患者、肿瘤和治疗特征。通过Kaplan-Meier法估计无病生存率和总生存率。通过 chi(2) 和 Fisher 精确检验比较比例。使用 Cox 比例风险模型进行单变量和多变量生存分析。结果：在 1,543 名 III 期结肠癌患者中，250 名 (16.2%) 出现梗阻。梗阻患者完成 12 个周期辅助化疗的可能性相同（75.9% vs 77.1%，P=.6）。幸存者的中位随访时间为 30.9 个月，梗阻患者的五年总生存率和无病生存率较差（总生存率 67.7% vs 78.0%，P < .001；无病生存率 53.9% vs 67.0%，P < .0001）。在多变量分析中，调整 T 分期、N 分期、体力状态、年龄、性别、组织学分级和体重指数后，梗阻仍然与较差的生存率显着相关（总生存风险比 1.57，95% 置信区间 1.12-2.20，P=.001；无病生存 1.52，95% 置信区间 1.18-1.95，P < .001）。结论：在本次前瞻性研究中对接受辅助化疗的 III 期结肠癌患者进行的随访发现，梗阻与复发和较差的生存率相关。此外，这种效应与 T 和 N 分期以及组织学分级无关。这些结果表明，阻塞应纳入新的风险分层模型中。 (C) 2018 Elsevier Inc. 保留所有权利。
Background: Patients with colon cancer often present with obstruction. Large series have reported obstruction among the high-risk features, yet prospective data on its specific prognostic influence are lacking. We hypothesized that obstruction is an independent risk factor for poor prognosis in patients with stage III colon cancer.Methods: N0147 was a trial conducted between 2004 and 2009 that randomly assigned patients with stage Ill colon cancer to adjuvant regimens of folinic acid (leucovorin calcium), fluorouracil, and oxaliplatin or fluorouracil, leucovorin, and irinotecan, with or without cetuximab. Patient-level data from the control chemotherapy-only arms were obtained. Patient, tumor, and treatment characteristics were abstracted. Disease-free survival and overall survival were estimated by the Kaplan-Meier method. Proportions were compared by chi(2) and Fisher exact tests. Univariable and multivariable survival analyses were performed using Cox proportional hazards models.Results: Of 1,543 patients with stage Ill colon cancer, 250 (16.2%) presented with obstruction. Patients with obstruction were equally likely to complete 12 cycles of adjuvant chemotherapy (75.9% vs 77.1%, P=.6). With median follow-up time of 30.9 months among survivors, five-year overall survival and disease-free survival were worse among patients with obstruction (overall survival 67.7% vs 78.0%, P < .001; disease-free survival 53.9% vs 67.0%, P < .0001). On multivariable analysis, obstruction remained significantly associated with worse survival after adjusting for T stage, N stage, performance status, age, sex, histologic grade, and body mass index (overall survival hazard ratio 1.57, 95% confidence interval 1.12-2.20, P=.001; disease-free survival 1.52, 95% confidence interval 1.18-1.95, P < .001).Conclusion: In this prospectively followed cohort of patients with stage Ill colon cancer treated with adjuvant chemotherapy, obstruction was associated with recurrence and worse survival. Moreover, this effect was independent of T and N stage and histologic grade. These results suggest that obstruction should be incorporated into novel risk-stratification models. (C) 2018 Elsevier Inc. All rights reserved.