The Circumferential Resection Margin Is a Prognostic Predictor in Colon Cancer
The Circumferential Resection Margin Is a Prognostic Predictor in Colon Cancer
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圆周切除边缘是结肠癌的预后预测因子
DOI：
10.3389/fonc.2020.00927
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发表时间：
2020-06-26
影响因子：
4.7
通讯作者：
Chu, Xiao-Yuan
中科院分区：
文献类型：
--
作者：
Tang, Xin-Yi;Huang, Meng-Xi;Chu, Xiao-Yuan
目的：探讨环切缘在结肠癌根治术中的应用价值。背景资料概要：CRM作为直肠癌和食管癌的重要预后因子已被广泛研究，但在结肠癌中尚未发现。研究方法：来自2010-2015年诊断为结肠癌的6，681例CRM阳性患者和25，908例CRM阴性患者的数据来自监测，流行病学和最终结果数据库。使用的统计分析方法包括卡方检验、Kaplan-Meier估计值、考克斯比例和X-tile软件分析。结果：经倾向评分匹配后，CRM阳性率与生存率呈负相关（P < 0.001）。X-tile软件将0和30 mm确定为预后的最佳临界值（P < 0.001），仅适用于II-IV期患者。在CRM介于0和30 mm之间[95%置信区间（CI）= 0.76-0.84]和大于30 mm（95% CI = 0.62-0.71）的患者中，分别观察到20%和33%的风险降低。化疗对预后有显著影响，总生存期（OS）的风险比为0.36（95%CI = 0.34-0.38）。与其他组相比，CRM值为0-30 mm的患者似乎从化疗中获益最多。CRM和区域淋巴结数量是独立的危险因素，后者是一个很好的替代CRM在AJCC I期患者。结论：CRM阳性是结肠癌患者的一个强有力的不利生存指标。CRM值大于30 mm时，预期结局更好。该临界值仅适用于II-IV期患者。对于I期患者，区域淋巴结数量是预测生存的良好替代品。化疗是另一个有利的预后因素，特别是对于CRM值在0和30 mm之间的患者。
Objective: This study aimed to investigate the potential value of circumferential resection margin (CRM) in colon cancer prognostics. Summary Background Data: CRM has been extensively studied as an important prognostic factor in rectal and esophageal cancer, but not in colon cancer. Methods: Data from 6,681 CRM-positive patients and 25,908 CRM-negative patients diagnosed with colon cancer in 2010–2015 were obtained from the Surveillance, Epidemiology, and End Results database. Statistical analysis methods utilized included the chi-square test, Kaplan-Meier estimates, Cox proportional, and X-tile software analyses. Results: After propensity score matching, CRM positivity was found to be negatively related with survival (P < 0.001). X-tile software identified 0 and 30 mm as optimal cutoff values (P < 0.001) for prognosis, which was applicable only in stage II–IV patients. A 20 and 33% risk decrease were observed in patients with CRM between 0 and 30 mm [95% confidence interval (CI) = 0.76–0.84], and larger than 30 mm (95% CI = 0.62–0.71), respectively. Chemotherapy strongly benefited prognosis with a hazard ratio of 0.36 (95% CI = 0.34–0.38) for overall survival (OS). Patients with a CRM value of 0–30 mm seemed to benefit most from chemotherapy compared with other groups. CRM and number of regional lymph nodes are independent risk factors, and the latter is a good substitute for CRM in AJCC stage I patients. Conclusion: CRM positivity is a strong unfavorable survival indicator for colon cancer patients. A better outcome is expected with CRM values larger than 30 mm. This cutoff value only applied to stage II–IV patients. For stage I patients, number of regional lymph nodes is a good substitute to predict survival. Chemotherapy was another favorable prognostic factor, especially for patients with a CRM value between 0 and 30 mm.