什么因素影响了结直肠癌患者长期生存特征?
  • 纳入738例于1999-2003年确诊的CRC患者数据,用Cox模型分析患者生存结果与各变量的关联;
  • 随访中,约61%患者死亡, 约26%死于CRC,10%和20%分别经历复发和转移;
  • 晚期、复发、转移与死亡风险密切相关,六年生存期后该因素带来的死亡风险极大降低;
  • 某些情况下,变量的影响在随访过程中恒定,如高微卫星不稳性和更高年龄预示了更长的无转移生存期;
  • 另一些情况下,变量的影响随时间变化,如确诊5.5年后,辅助放疗与更高的转移风险相关。
主编推荐语
楂小夭
最新发表在BMC Medicine的研究对738例结直肠癌患者进行长达19年的随访,旨在评估影响结直肠癌患者长期生存特征的各种可能因素及其影响效果。Cox模型用于分析各变量与各种生存期(如总存活数、疾病特异性生存期、无复发生存率、无转移生存期、无复发无转移生存期、无事件生存 )的相关性。该研究结果促进了对结直肠癌长期预后特征的理解,并有望启发未来的研究和临床护理策略。
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BMC Medicine [IF:8.285]

The long-term survival characteristics of a cohort of colorectal cancer patients and baseline variables associated with survival outcomes with or without time-varying effects

一个队列的结直肠癌患者长期生存特征和与有时变效应或无时变效应生存结果相关的基线变量

10.1186/s12916-019-1379-5

2019-07-29, Article

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BACKGROUND: Colorectal cancer is the third most common cancer in the world. In this study, we assessed the long-term survival characteristics and prognostic associations and potential time-varying effects of clinico-demographic variables and two molecular markers (microsatellite instability (MSI) and BRAF Val600Glu mutation) in a population-based patient cohort followed up to ~ 19 years.
METHODS: The patient cohort included 738 incident cases diagnosed between 1999 and 2003. Cox models were used to analyze the association between the variables and a set of survival outcome measures (overall survival (OS), disease-specific survival (DSS), recurrence-free survival (RFS), metastasis-free survival (MFS), recurrence/metastasis-free survival (RMFS), and event-free survival (EFS)). Cox proportional hazard (PH) assumption was tested for all variables, and Cox models with time-varying effects were used if any departure from the PH assumption was detected.
RESULTS: During the follow-up, ~ 61% patients died from any cause, ~ 26% died from colorectal cancer, and ~ 10% and ~ 20% experienced recurrences and distant metastases, respectively. Stage IV disease and post-diagnostic recurrence or metastasis were strongly linked to risk of death from colorectal cancer. If a patient had survived the first 6 years without any disease-related event (i.e., recurrence, metastasis, or death from colorectal cancer), their risks became very minimal after this time period. Distinct sets of markers were associated with different outcome measures. In some cases, the effects by variables were constant throughout the follow-up. For example, MSI-high tumor phenotype and older age at diagnosis predicted longer MFS times consistently over the follow-up. However, in some other cases, the effects of the variables varied with time. For example, adjuvant radiotherapy treatment was associated with increased risk of metastasis in patients who received this treatment after 5.5 years post-diagnosis, but not before that.
CONCLUSIONS: This study describes the long-term survival characteristics of a prospective cohort of colorectal cancer patients, relationships between baseline variables and a detailed set of patient outcomes over a long time, and time-varying effects of a group of variables. The results presented advance our understanding of the long-term prognostic characteristics in colorectal cancer and are expected to inspire future studies and clinical care strategies.

First Authors:
Yajun Yu

Correspondence Authors:
Sevtap Savas

All Authors:
Yajun Yu,Megan Carey,William Pollett,Jane Green,Elizabeth Dicks,Patrick Parfrey,Yildiz E Yilmaz,Sevtap Savas

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