Survival analysis in pT1-3 and paracolic lymph-node invasion colorectal cancer: the prognostic role of positive paracolic lymph-node ratio for adjuvant chemotherapy.

IF 2.8 3区医学 Q2 ONCOLOGY Clinical & Translational Oncology Pub Date : 2024-12-01 Epub Date: 2024-05-23 DOI:10.1007/s12094-024-03470-z

Xiaochuang Feng, Weilin Liao, Yuqing Tang, Xiaojiang Yi, Tieqiao Tian, Hongming Li, Jiaxin Lin, Xinquan Lu, Jin Wan, Jiahao Wang, Haijun Deng, Chuangqi Chen, Dechang Diao

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Abstract

Purpose: Several studies have observed that some stage III colorectal cancer (CRC) patients cannot benefit from standard adjuvant chemotherapy. However, there is no unified screening standard to date.

Methods: Consecutive patients with pathologically confirmed colon adenocarcinoma treated in 3 centers between January 2016 and December 2018 were included. Patients were divided into four groups according to different stages and positive paracolic lymph-node ratio (P-LNR) [Cohort 1: pT1-3N0M0, Cohort 2: pT1-3N + (P-LNR ≤ 0.15)M0, Cohort 3: pT4N0M0, Cohort 4: stage III patients except for pT1-3N + (P-LNR ≤ 0.15)M0], and further overall survival was compared by Kaplan-Meier method. The univariate and multivariate analyses were employed for cox proportional hazards model.

Results: We retrospectively reviewed 5581 consecutive CRC patients with, and 2861 eligible patients were enrolled for further analysis. The optimal cut-off value of P-LNR in our study was 0.15. There was no significant difference in OS (91.36 vs. 93.74%) and DFS (87.65 vs. 90.96%) between stage III patients with pT1-3N + (P-LNR ≤ 0.15)M0 and those with pT1-3N0M0. Further analysis demonstrated that CRC patients with pT1-3N + (P-LNR ≤ 0.15)M0 were less likely to benefit from 8 cycles of CAPOX or FOLFOX chemotherapy and suffered fewer adverse events from declining chemotherapy. Comparing with 0-4 cycles versus 8 cycles, the overall survival rates were 91.35 versus 90.19% (P = 0.79), and with a DFS of 87.50 versus 88.24% (P = 0.49), the duration of adjuvant chemotherapy was not an independent risk factor for patients with pT1-3N + (P-LNR ≤ 0.15)M0 (HR: 0.70, 95% CI 0.90-1.30, P = 0.42).

Conclusion: The concept of P-LNR we proposed might have a high clinical application value and accurately enable clinicians to screen out specific CRC patients who decline or prefer limited chemotherapy.

Trial registry: The clinical trial registration number: ChiCTR2300076883.

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pT1-3和旁淋巴结侵犯结直肠癌的生存率分析：旁淋巴结阳性率对辅助化疗的预后作用。

目的：多项研究发现，一些 III 期结直肠癌（CRC）患者无法从标准辅助化疗中获益。然而，迄今为止还没有统一的筛查标准：纳入2016年1月至2018年12月期间在3个中心接受治疗的病理确诊结肠腺癌患者。根据不同分期和阳性旁淋巴结比（P-LNR）将患者分为四组[队列1：pT1-3N0M0，队列2：pT1-3N+（P-LNR≤0.15）M0，队列3：pT4N0M0，队列4：除pT1-3N+（P-LNR≤0.15）M0外的III期患者]，并采用Kaplan-Meier法进一步比较总生存期。采用cox比例危险度模型进行单变量和多变量分析：我们对 5581 例连续的 CRC 患者进行了回顾性分析，并对 2861 例符合条件的患者进行了进一步分析。在我们的研究中，P-LNR的最佳临界值为0.15。pT1-3N+（P-LNR≤0.15）M0的III期患者与pT1-3N0M0的患者在OS（91.36% vs. 93.74%）和DFS（87.65% vs. 90.96%）方面无明显差异。进一步分析表明，pT1-3N +（P-LNR ≤ 0.15）M0 的 CRC 患者从 8 个周期的 CAPOX 或 FOLFOX 化疗中获益的可能性较小，且因拒绝化疗而发生的不良事件较少。0-4个周期与8个周期相比，总生存率为91.35%对90.19%（P=0.79），DFS为87.50%对88.24%（P=0.49），辅助化疗持续时间不是pT1-3N+（P-LNR≤0.15）M0患者的独立危险因素（HR：0.70，95% CI 0.90-1.30，P=0.42）：结论：我们提出的P-LNR概念可能具有较高的临床应用价值，可使临床医生准确筛选出拒绝或倾向于有限化疗的特定CRC患者：临床试验注册号：ChiCTR2300076883ChiCTR2300076883。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical & Translational Oncology 医学-肿瘤学

CiteScore

6.20

自引率

2.90%

发文量

240

审稿时长

1 months

期刊介绍： Clinical and Translational Oncology is an international journal devoted to fostering interaction between experimental and clinical oncology. It covers all aspects of research on cancer, from the more basic discoveries dealing with both cell and molecular biology of tumour cells, to the most advanced clinical assays of conventional and new drugs. In addition, the journal has a strong commitment to facilitating the transfer of knowledge from the basic laboratory to the clinical practice, with the publication of educational series devoted to closing the gap between molecular and clinical oncologists. Molecular biology of tumours, identification of new targets for cancer therapy, and new technologies for research and treatment of cancer are the major themes covered by the educational series. Full research articles on a broad spectrum of subjects, including the molecular and cellular bases of disease, aetiology, pathophysiology, pathology, epidemiology, clinical features, and the diagnosis, prognosis and treatment of cancer, will be considered for publication.