重温第二阶段IIB/C和第二阶段IIIA结肠癌之间的生存悖论
Cheng Yu1, Zhiliang Shi1, Guoqiang Zhou1
1Department of General Surgery, Affiliated Changshu Hospital of Nantong University, Changshu, 215500, China.
Scientific reports
|September 28, 2024
概括
大肠癌患者在IIB/C阶段的生存率比IIIA阶段更差,这挑战了目前的分期. 这种悖论凸显了需要修订标准的必要性,可能包括更先进的标记物,以提高预后准确度.
科学领域:
- 在瘤学瘤学.
- 癌症研究 癌症研究
- 临床分期确定 临床分期确定
背景情况:
- 患有IIB/C期结肠癌 (T4a-bN0) 的患者通常比IIIA期 (T1-2N1,T1N2a) 患者的生存率更差.
- 存在一种生存悖论,在早期阶段 (IIB/C) 的更先进的局部瘤特征 (T4) 与较高节点阶段 (IIIA) 的较不先进的局部特征 (T1-2) 相比,与更糟糕的结果有关.
研究的目的:
- 用最近的监测,流行病学和最终结果 (SEER) 数据重新评估结肠癌生存悖论.
- 通知美国癌症联合委员会 (AJCC) 对结肠癌的分期标准的潜在修订.
主要方法:
- 分析了4692名在2018年至2021年期间被诊断为结肠癌的患者,使用SEER数据和第8版TNM分期标准.
- 统计分析包括千平方测试,考克斯回归和卡普兰-梅尔生存分析,以评估癌症特异性生存率 (CSS) 和整体生存率 (OS).
主要成果:
- 与IIIA阶段 (CSS 91%,OS 83.1%) 患者相比,IIB/C阶段的结肠癌患者的3年CSS率 (73.1%,70.3%) 和OS率 (64.9%,63.0%) 显著较低.
- 多变量分析显示,IIIA阶段患者与IIB阶段患者相比,癌症特异性死亡率 (HR=0.374) 和总死亡率 (HR=0.575) 的风险明显较低.
- 这些发现证实了生存悖论,IIB/C阶段的结果比IIIA阶段更差.
结论:
- 目前的AJCC结肠癌分期系统可能不会准确地反映预后,因为观察到的生存悖论.
- 第九版AJCC分期系统应该考虑整合先进的诊断标记,并强调T4瘤的侵略性生物学.
- 需要进行修订,以提供更准确的预后信息,并指导结肠癌患者的有效治疗策略.
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