多原发与单原发大肠腺癌的预后分析

Prognostic analysis of multiple primary and single primary colorectal adenocarcinoma

目的本研究采用倾向评分匹配(PSM)探究多原发大肠腺癌与单原发大肠腺癌的预后差异。方法回顾性收集2008年1月至2020年12月在贵州医科大学附属肿瘤医院及贵州医科大学附属医院经病理组织学确诊为大肠腺癌的患者资料,并根据是否多发分为多原发组和单原发组两组,其中多原发组95例,单原发组313例。采用Kaplan-Meier法绘制生存曲线比较两组生存情况。分别以5年生存率及2年生存率作为Ⅰ~Ⅲ期及Ⅳ期患者在本研究中的结局变量。通过多因素Cox回归模型分析多原发对大肠癌预后影响。再基于倾向评分(PS),通过PSM、逆概率加权法模型(IPTW)、倾向性评分协变量调整模型(PS-adjusted)进一步分析和验证多原发对大肠腺癌预后的影响。结果Ⅰ~Ⅲ期患者中单原发组5年生存率较多原发组具有显著生存优势(66%比50%,P<0.0001)。多因素的Cox回归分析显示,Ⅰ~Ⅲ期患者中多原发是大肠腺癌预后的独立危险因素,而在Ⅳ期患者中两组预后未见明显差异,HR(95%CI)分别为2.07(1.31~3.26)、1.52(0.78~2.94),P值分别为0.002、0.042。Ⅰ~Ⅲ期患者,PSM、逆概IPTW、PS-adjusted中均得出一致的结果,多原发显著增加了Ⅰ~Ⅲ期大肠癌患者的远期死亡风险,HR(95%CI)分别为2.41(1.46~3.97)、2.8(1.53~5.09)、2.07(1.33~3.23),P均<0.05。Ⅳ期患者PSM模型中表明,多原发未显著增加IV期大肠腺癌患者的死亡风险,HR(95%CI)为1.88(0.9~3.94),P=0.092;在IPTW模型及PS-adjusted模型中得出一致结论,HR(95%CI)分别为3.39(1.49~7.72)、2.11(1.09~4.1),P均<0.05。结论本研究通过基于PS多模型分析进一步验证了相较于单原发,多原发显著增加了Ⅰ~Ⅲ期大肠腺癌患者的远期死亡风险,但多原发未显著增加IV期大肠腺癌患者的死亡风险。

Objective To explore the prognostic differences between multiple primary colorectal adenocarcinoma and single primary colorectal adenocarcinoma using propensity score matching(PSM).Methods The data of patients with colorectal adenocarcinoma diagnosed by histopathology in the Cancer Hospital Affiliated to Guizhou Medical University and the Affiliated Hospital of Guizhou Medical University from January 2008 to December 2020 were retrospectively collected,and were divided into two groups according to whether there were multiple primary tumors:multiple primary group(95 cases)and single primary group(313 cases).Survival curves were drawn using Kaplan-Meier method to compare the survival status of the two groups.The 5-year survival rate and 2-year survival rate were used as outcome variables for patients in stages Ⅰ-Ⅲ and Ⅳ in this study.The impact of multiple primary factors on the prognosis of colorectal cancer through a multivariate Cox regression model.Based on propensity score(PS),the impact of multiple primary factors on the prognosis of colorectal cancer was further analyzed and validated through PSM,inverse probability weighted model(IPTW),and propensity score covariate adjusted model(PS-adjusted).Results In stage Ⅰ-Ⅲ patients,the 5-year survival rate of the single primary group was higher than that of the multiple primary group(66%vs.50%,P<0.0001).Multivariate Cox regression analysis showed that multiple primary factors were independent risk factors for the prognosis of colorectal cancer in stage Ⅰ-Ⅲ patients,while there was no significant difference in prognosis between the two groups in stage Ⅳ patients.HR(95%CI)were 2.07(1.31-3.26)and 1.52(0.78-2.94),respectively,with P=0.002 and P=0.042,respectively.In stage Ⅰ-Ⅲ patients,consistent results were obtained in PSM,IPTW,and PS-adjusted.Multiple primary factors significantly increased the risk of long-term death in stage Ⅰ-Ⅲ colorectal cancer patients,with HR(95%CI)of 2.41(1.46-3.97),2.8(1.53-5.09),and 2.07(1.33-3.23),respectively(all P<0.05).The PSM model for stage Ⅳ patients showed that multiple primary cancers did not significantly increase the risk of death in stageⅣcolorectal cancer patients,with HR(95%CI)of 1.88(0.9-3.94)and P=0.092.Consistent conclusions were drawn in the IPTW model and the PS-adjusted model,with HR(95%CI)of 3.39(1.49,7.72)and 2.11(1.09,4.1),respectively(both P<0.05).Conclusion This study further validates that compared with single primary cancer,multiple primary cancers significantly increase the long-term mortality risk of Ⅰ-Ⅲ stage colorectal cancer patients,but multiple primary cancers did not significantly increase the mortality risk ofⅣstage colorectal cancer patients.