Prognostic evaluation of stage B colon cancer patients is improved by an adequate lymphadenectomy - Results of a secondary analysis of a large scale adjuvant trial
Prognostic evaluation of stage B colon cancer patients is improved by an adequate lymphadenectomy - Results of a secondary analysis of a large scale adjuvant trial
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DOI：
10.1097/00000658-200204000-00002
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发表时间：
2002-04-01
影响因子：
9
通讯作者：
Rosso, R
中科院分区：
文献类型：
--
作者：
Prandi, M;Lionetto, R;Rosso, R
目的探讨B期和0期结肠癌术后淋巴结切除程度（淋巴结数量）与远期预后的关系。背景资料淋巴扩散是结肠癌患者的主要预后指标，但淋巴结切除术的最佳范围及其对预后的影响尚不清楚。方法对连续两项INTACC多中心结肠癌辅助治疗试验的3648例患者（中位随访3.6年），通过单因素和Cox回归分析，研究淋巴结恢复数与总生存期和无复发生存期的关系。结果总生存期最差的患者年龄为0 ~ 65岁，风险比[RR] = 1.30，分级较高（RR = 1.96）。较好的总生存率与女性（RR = 0.80）和较高的淋巴结数量（8-12个，RR = 0.46, 13-17个，RR = 0.76，淋巴结>/= 18,RR = 0.79）有关。无复发生存期也观察到相同的模式。较长的总生存期和无复发生存期与较高的淋巴结数量相关，分别为P = 0.034和P = 0.003（阳性淋巴结缺失或存在的分层分析），标本中少于7个淋巴结的B期患者的总生存期（P = 0.00000）和无复发生存期（P = 0.0016）均短于其他B期患者。C期患者预后与淋巴结恢复数无关（P = 28, P = 0.12）。疾病分期与淋巴结恢复数的交互作用检验有统计学意义（P = 0.017）。结论8期患者有少量淋巴结检查可能是隐性的。因此，这些患者可能会考虑辅助治疗，因为他们的预期寿命比其他B期患者短。对于C期患者，淋巴结恢复的数量似乎不影响长期预后。
Objective To determine if the extent of lymphadenectomy (number of recovered lymph nodes) was associated with long-term outcome in patients operated on for stage B and 0 colon cancer.Summary Background Data Lymphatic spreading is the main prognostic indicator in colon cancer patients, although the optimal extent of lymphadenectomy and its prognostic impact are still unknown.Methods In 3,648 patients (median follow-up 3.6 years) enrolled in two consecutive INTACC multicentric trials on adjuvant therapy for colon cancer, we studied the association of the number of recovered nodes with overall survival and relapse free survival by means of univariate and Cox regression analysis.Results The worst overall survival was related to ages > 65 (risk ratio [RR] = 1.30), higher grading (RR = 1.96). Better overall survival was related to female gender (RR = 0.80) and to higher number of recovered nodes (8-12 nodes, RR = 0.46, 13-17 nodes, RR = 0.76, nodes >/= 18, RR = 0,79). The same pattern was observed for relapse free survival. Longer overall and relapse free survival were related to a higher number of recovered nodes with P = .034 and P = .003 respectively (stratified analysis for absence or presence of positive nodes), Stage B patients with fewer than 7 nodes in the specimen had both shorter overall survival (P = .0000) and relapse free survival (P = .0016) than the other B patients. Outcome of stage C patients was not related to the number of recovered nodes (P = 28 and 0, 12 respectively). The interaction test between stage of disease and number of recovered nodes was statistically significant (P = .017).Conclusions Stage 8 patients with a small number of examined nodes may be understaged. Thus, these patients might be considered for adjuvant therapy because of their poorer life expectancy than other stage B patients. For stage C patients, the number of recovered nodes does not seem to affect long-term outcome.