Adenosquamous carcinoma of the colon, rectum, and anus - Epidemiology, distribution, and survival characteristics
Adenosquamous carcinoma of the colon, rectum, and anus - Epidemiology, distribution, and survival characteristics
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DOI：
10.1007/bf02237138
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发表时间：
1999-02-01
影响因子：
3.9
通讯作者：
Fry, RD
中科院分区：
文献类型：
--
作者：
Cagir, B;Nagy, MW;Fry, RD
目的：英文文献报道了 49 例结肠、直肠和肛门腺鳞癌。我们回顾了 145 例腺鳞癌病例，以更好地确定这种极其罕见的结肠癌的流行病学和生存特征。方法：对美国国家癌症研究所 1973 年至 1992 年的监测、流行病学和最终结果计划公用 CD-ROM 文件进行了审查。这约占美国人口的 9.5%。使用国际疾病分类-O 代码来识别结肠、直肠和肛门中出现的腺鳞癌。 Astler-Coller 肿瘤分类用于分期。使用双尾学生 t 检验、Mantel-Haenszel 卡方检验和广义 Wilcoxon 检验来比较平均值。分别为比例和精算生存率。通过Kaplan-Meier方法计算生存曲线。结果：共鉴定出 145 例腺鳞癌，占所有结直肠恶性肿瘤的 0.06%。患者的平均年龄为 67 岁。 84% 的患者只是白种人，15% 是非裔美国人，1% 是其他种族。非裔美国人的诊断年龄明显更年轻（中位年龄 62 岁；P = 0.03）。 53% 的癌位于乙状结肠、直肠和肛门，28% 位于右结肠，其余位于中段。 74% 的远端病例处于 A 至 C 期，而近端病例的这一比例为 44%。乙状结肠、直肠和肛门腺鳞癌患者的存活时间比所有其他患者更长（P = 0.001）。 A 期和 B-1 期腺鳞癌患者的生存率与相应分期腺癌患者相似。百分之五十的患者，包括大多数 D 期患者，在第一年死亡。 B-2、C 和 D 期腺鳞癌患者的生存期明显短于相应分期的腺癌患者（P 小于或等于 0.02）。总体调整后五年生存率为 30.7%。在那些存活超过 24 个月的患者中，五年存活率为 84%。结论：A 期和 B-1 期腺鳞癌患者的生存率与相应分期的结直肠腺癌患者相似。然而，我们发现 B-2 至 D 期结直肠和肛门腺鳞癌患者的生存率明显低于相应分期的腺癌患者，这支持了之前关于腺鳞癌预后不良的报道。
PURPOSE: There have been 49 cases of adenosquamous carcinoma of the colon rectum, and anus reported in the English literature. We have reviewed 145 cases of adenosquamous carcinoma to better define epidemiologic and survival characteristics of this extremely rare colon carcinoma. METHODS: The National Cancer Institute's Surveillance, Epidemiology, and End Results program public use CD-ROM file for the years 1973 through 1992 were reviewed. This represents approximately 9.5 percent of the United States population. Adenosquamous carcinomas arising in the colon, rectum, and anus were identified using the international Classification of Diseases-O codes. The Astler-Coller tumor classification was used for staging. Two-tailed Student's t-test, Mantel-Haenszel chi-squared tests, and generalized Wilcoxon's tests were used for comparisons of means. proportions, and actuarial survival rates, respectively. Survival curves were calculated by the Kaplan-Meier method. RESULTS: One hundred forty-five cases of adenosquamous carcinoma were identified, representing 0.06 percent of all colorectal malignancies. The mean age of patients was 67 years. Eighty-four percent of patients mere Caucasians, 15 percent were Afro-Americans, and 1 percent were other races. Afro-Americans were diagnosed at a significantly younger age (median age, 62 years; P = 0.03). Fifty-three percent of the carcinomas were located in the sigmoid colon, rectum, and anus, 28 percent in the right colon, and the rest in the middle segment. Seventy-four percent of distal cases were staged A through C, compared with 44 percent of proximal cases. Patients with adenosquamous carcinoma of the sigmoid colon, rectum, and anus survived longer than all other patients (P = 0.001). Patients with adenosquamous carcinoma Stages A and B-1 had survival rates similar to patients with comparably staged adenocarcinomas. Fifty percent of the patients, including most of the patients with D stage, died in the first year. Patients with Stages B-2, C, and D adenosquamous carcinomas had a significantly shorter survival than the comparably staged adenocarcinomas (P less than or equal to 0.02). The overall adjusted five-year survival rate was 30.7 percent. In those patients who survived more than 24 months, the five-year survival was 84 percent. CONCLUSIONS: The survival rates for patients with adenosquamous carcinoma Stages A and B-1 are similar to patients with comparably staged colorectal adenocarcinomas. However, we found that patients with colorectal and anal adenosquamous carcinomas staged B-2 through D have significantly poorer survival than patients with comparably staged adenocarcinomas, supporting the previous reports of a poor prognosis associated with adenosquamous carcinomas.