Prognostic analysis of multiple primary and single primary colorectal adenocarcinoma
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＜0.000 1).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-Ⅲcolorectal 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 stage Ⅳ colorectal 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 of Ⅳ stage colorectal cancer patients.
万方数据
维普
