Using Simple Blood Test and Pathological Risk Factors in Combination to Predict Stage-II Colorectal Cancer Recurrence Risk

第二期大腸直腸癌復發之因素分析

鍾伯康(Bor-Kang Jong) ； 陳繹中(Yih-Jong Chern) ； 許祐仁(Yu-Jen Hsu) ； 洪欣園(Hsin-Yuan Hung) ； 蔡文司(Wen-Sy Tsai) ； 謝寶秀(Pao-Shiu Hsieh) ； 江支銘(Jy-Ming Chiang) ； 蔣昇甫(Sum-Fu Chiang) ； 賴正洲(Cheng-Chou Lai) ； 唐瑞平(Reiping Tang) ； 陳進勛(Jinn-Shiun Chen) ； 葉建裕(Chien-Yuh Yeh) ； 游正府(Jeng-Fu You)

《中華民國大腸直腸外科醫學會雜誌》 31卷4期 (2020/12) Pp. 276-285

https://doi.org/10.6312/SCRSTW.202012_31(4).10918

摘要

Background and Objectives. Current guidelines recommend adjuvant chemotherapy for high-risk stage-II colorectal cancer, but to date, its therapeutic benefit has been minor. Therefore, identifying other indicators to help select appropriate patients for adjuvant treatment is necessary. We aimed to identify all the possible high-risk factors in stage-II colorectal cancer patients. Methods. Between January 2004 and December 2011, we evaluated 1563 patients with well-documented clinicopathological characteristics who underwent curative resection for stage-II primary colorectal adenocarcinoma at a single institution. Results. After a median follow-up of 5.9 years, the overall recurrence rate was 14.3%. Independent predictors, such as rectal cancer, T4-stage tumor, bowel obstruction, perineural invasion, and carcinoembryonic antigen (CEA) and albumin levels were significantly related to a high tumor recurrence risk. Patients with combined neutrophil and monocyte-to-lymphocyte count ratio (NM-L ratio) of ＞ 4.3 had a relatively high rate of recurrence (＞ 4.3 vs. ≤ 4.3, 21.3% vs. 11.6%, p ＜ 0.001); this was confirmed by multivariate analysis (hazard ratio, 1.653; p = 0.004). The median disease- free and overall survival rates of the high NM-L ratio group were both inferior to those of the low NM-L ratio group. Combining the aforementioned pathological and blood test-related risk factors, the overall risk of recurrence increased to 24.7% (odds ratio, 3.5). Conclusion. In addition to the well-known clinicopathological characteristics, some simple blood tests can determine a patient's CEA and albumin levels and NM-L ratio. These data can be used to generate a prognostic prediction. Further research on the effects of adjuvant chemotherapy on patients with stage-II colorectal cancer is warranted.

關鍵字

CEA ； Albumin ； Neutrophil ； Monocyte ； Lymphocyte ； Colorectal cancer

並列摘要

背景：目前國際治療準則建議第二期大腸直腸癌患者若具備較高危險因子，可選擇接受輔助性化學治療。但目前研究證據顯示此類病患接受化療之後的幫助並不顯著。我們認為可能尚有其他臨床危險因子並未被發現，因此影響成效。方法：挑選本院2004年至2011年第二期大腸直腸癌接受根除性切除但排除接受放射治療之病患。比較其手術前臨床因子、手術後病理因子及後續復發之關係。結果：在這群患者之中，整體的復發比率為14%，中位追蹤年份為5.9年。影響較高復發機率的因子有直腸癌患者、T4腫瘤、腸阻塞、近神經侵犯、較高的癌胚抗原數值以及較低的白蛋白數值。若（嗜中性白血球＋單核球）／淋巴球之比值大於4.3，亦有較高的復發機率（＞ 4.3 vs. ≤ 4.3, 21.3% vs. 11.6%, p ＜ 0.001）。若將前述的病理因子及臨床因子合併計算，總體復發機率將增加至24.7%（OR = 3.5）。結論：結合在本研究中的各項臨床及病理因子，可進一步找出可能復發之大腸直腸癌第二期病患。但仍須探討化學治療是否對此類病患有效。

並列關鍵字

癌胚抗原 ； 白蛋白 ； 嗜中性白血球 ； 單核球 ； 淋巴球 ； 大腸直腸癌

參考文獻

Edge, S.B. and C.C. Compton, The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol, 2010. 17(6): p. 1471-4.

Andre, T., et al., Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med, 2004. 350(23): p. 2343-51.

Andre, T., et al., Improved overall survival with oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment in stage II or III colon cancer in the MOSAIC trial. J Clin Oncol, 2009. 27(19): p. 3109-16.

Twelves, C., et al., Capecitabine as adjuvant treatment for stage III colon cancer. N Engl J Med, 2005. 352(26): p. 2696-704.

Bockelman, C., et al., Risk of recurrence in patients with colon cancer stage II and III: a systematic review and meta-analysis of recent literature. Acta Oncol, 2015. 54(1): p. 5-16.