早期结直肠癌中原发肿瘤侧性与预后相关性的综合分析：基于四个随机对照试验（JCOG2003A）的研究
Prognostic Relevance of Primary Tumor Sidedness in Early-Stage Colorectal Cancer: An Integrated Analysis of Four Randomized Controlled Trials (JCOG2003A).
发表日期：2023 Aug 08
作者：
Akira Ouchi, Ryo Sadachi, Tetsuya Hamaguchi, Shunsuke Tsukamoto, Yasuhiro Shimada, Masafumi Inomata, Yasumasa Takii, Koji Komori, Akio Shiomi, Manabu Shiozawa, Masayuki Ohue, Jun Watanabe, Masaaki Ito, Yoshiyuki Kawashima, Takaya Kobatake, Hiroaki Souda, Yoshihisa Saida, Tadayoshi Hashimoto, Yusuke Sano, Yukihide Kanemitsu,
来源：
ANNALS OF SURGERY
摘要：
为了确定原发性肿瘤位置（PTS）在早期结直肠癌（CRC）患者中的真正预后相关性。PTS在早期CRC中的预后相关性仍是争议的话题。迄今为止，有几项大型流行病学研究仅调查了生存率，未考虑复发风险。我们分析了来自四项随机对照试验（RCTs）的结肠和上直肠腺癌（II/III期）。根据肿瘤位置：右侧（盲肠至横结肠）或左侧（降结肠至上直肠），比较了不同的存活结局。共分为右侧组（N=1,349）和左侧组（N=2,764）两组，共4,113名患者。在所有患者和每个分期中，原发手术后的无复发生存率与PTS无关（所有患者的经调整风险比1.024 [95% CI：0.886-1.183]；II期患者的风险比1.327 [0.852-2.067]；III期患者的风险比0.990 [0.850-1.154]）。同样，在所有患者和每个分期中，原发手术后的总体生存率与PTS无关（所有患者的经调整风险比0.879 [95% CI：0.726-1.064]；II期患者的风险比1.517 [0.738-3.115]；III期患者的风险比0.840 [0.689-1.024]）。总共有795名患者（右侧组N=257；左侧组N=538）在原发手术后发生复发。PTS与复发后总体生存率显著相关（经调整风险比0.773 [95% CI：0.627-0.954]）。PTS对II/III期CRC的复发风险没有影响。基于PTS的治疗分层对于早期CRC是不必要的。版权所有 © 2023 Wolters Kluwer Health，Inc.保留所有权利。
To determine the genuine prognostic relevance of primary tumor sidedness (PTS) in patients with early-stage colorectal cancer (CRC).The prognostic relevance of PTS in early-stage CRC remains a topic of debate. Several large epidemiological studies investigated survival only and did not consider the risk of recurrence so far.Patients with stage II/III adenocarcinoma of the colon and upper rectum from four randomized controlled trials (RCTs) were analyzed. Survival outcomes were compared according to the tumor location: right-sided (cecum to transverse colon) or left-sided (descending colon to upper rectum).A total of 4,113 patients were divided into a right-sided group (N=1,349) and a left-sided group (N=2,764). Relapse-free survival after primary surgery was not associated with PTS in all patients and each stage (HRadjusted 1.024 [95% CI 0.886-1.183] in all patients; 1.327 [0.852-2.067] in stage II; and 0.990 [0.850-1.154] in stage III). Also, overall survival after primary surgery was not associated with PTS in all patients and each stage (HRadjusted 0.879 [95% CI 0.726-1.064] in all patients; 1.517 [0.738-3.115] in stage II; and 0.840 [0.689-1.024] in stage III). In total, 795 patients (right-sided, N=257; left-sided, N=538) developed recurrence after primary surgery. PTS was significantly associated with overall survival after recurrence (HRadjusted 0.773 [95% CI 0.627-0.954]).PTS had no impact on the risk of recurrence for stage II/III CRC. Treatment stratification based on PTS is unnecessary for early-stage CRC.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.