Table_1_The Circumferential Resection Margin Is a Prognostic Predictor in Colon Cancer.docx

Objective: This study aimed to investigate the potential value of circumferential resection margin (CRM) in colon cancer prognostics.
Summary Background Data: CRM has been extensively studied as an important prognostic factor in rectal and esophageal cancer, but not in colon cancer.
Methods: Data from 6,681 CRM-positive patients and 25,908 CRM-negative patients diagnosed with colon cancer in 2010–2015 were obtained from the Surveillance, Epidemiology, and End Results database. Statistical analysis methods utilized included the chi-square test, Kaplan-Meier estimates, Cox proportional, and X-tile software analyses.
Results: After propensity score matching, CRM positivity was found to be negatively related with survival (P < 0.001). X-tile software identified 0 and 30 mm as optimal cutoff values (P < 0.001) for prognosis, which was applicable only in stage II–IV patients. A 20 and 33% risk decrease were observed in patients with CRM between 0 and 30 mm [95% confidence interval (CI) = 0.76–0.84], and larger than 30 mm (95% CI = 0.62–0.71), respectively. Chemotherapy strongly benefited prognosis with a hazard ratio of 0.36 (95% CI = 0.34–0.38) for overall survival (OS). Patients with a CRM value of 0–30 mm seemed to benefit most from chemotherapy compared with other groups. CRM and number of regional lymph nodes are independent risk factors, and the latter is a good substitute for CRM in AJCC stage I patients.
Conclusion: CRM positivity is a strong unfavorable survival indicator for colon cancer patients. A better outcome is expected with CRM values larger than 30 mm. This cutoff value only applied to stage II–IV patients. For stage I patients, number of regional lymph nodes is a good substitute to predict survival. Chemotherapy was another favorable prognostic factor, especially for patients with a CRM value between 0 and 30 mm.

研究目的：本研究旨在探讨环周切缘（circumferential resection margin, CRM）在结肠癌预后评估中的潜在应用价值。
研究背景：环周切缘（CRM）作为直肠癌与食管癌的重要预后因子已被广泛研究，但在结肠癌领域的相关研究仍较为匮乏。
研究方法：本研究从监测、流行病学与最终结果（Surveillance, Epidemiology, and End Results, SEER）数据库中，提取了2010至2015年确诊的6681例CRM阳性结肠癌患者与25908例CRM阴性结肠癌患者的临床数据。本研究采用的统计学分析方法包括卡方检验、Kaplan-Meier生存分析法、Cox比例风险模型以及X-tile软件分析。
研究结果：经倾向性评分匹配后发现，CRM阳性与患者生存预后呈显著负相关（P < 0.001）。X-tile软件确定了0mm与30mm作为预后评估的最优截断值（P < 0.001），该截断值仅适用于Ⅱ~Ⅳ期结肠癌患者。CRM值处于0~30mm区间的患者，其死亡风险降低20%[95%置信区间（confidence interval, CI）=0.76~0.84]；CRM值大于30mm的患者死亡风险降低33%[95% CI=0.62~0.71]。化疗可显著改善患者预后，其总体生存（overall survival, OS）的风险比为0.36（95% CI=0.34~0.38）。与其他组别患者相比，CRM值为0~30mm的患者似乎从化疗中获益最为显著。CRM与区域淋巴结数目均为独立风险因素，且在美国癌症联合委员会（American Joint Committee on Cancer, AJCC）Ⅰ期结肠癌患者中，区域淋巴结数目可作为CRM的良好替代预测指标。
研究结论：CRM阳性是结肠癌患者不良生存结局的强预测因子。CRM值大于30mm的患者预后更佳。该最优截断值仅适用于Ⅱ~Ⅳ期结肠癌患者。对于Ⅰ期结肠癌患者，区域淋巴结数目可作为预测生存情况的良好替代指标。化疗亦是一项有利的预后因素，尤其对于CRM值介于0~30mm的患者。