Prognostic Significance of Preoperative Bowel Obstruction in Stage III Colorectal Cancer
Prognostic Significance of Preoperative Bowel Obstruction in Stage III Colorectal Cancer
复制标题
DOI：
10.1245/s10434-011-1625-3
复制
发表时间：
2011-09-01
影响因子：
3.7
通讯作者：
Watanabe, Masahiko
中科院分区：
文献类型：
--
作者：
Katoh, Hiroshi;Yamashita, Keishi;Watanabe, Masahiko
以往的研究表明，术前梗阻近端结直肠癌（CRC）的不利预后影响。如果这种不利影响是保留在每个阶段的先进（第二或第三阶段）CRC，我们可以确定高危patients.We入组641例患者病理证实的先进CRC（第二阶段，n = 207;第三阶段，n = 434）谁经历了根治性切除的原发灶。评估术前梗阻与临床病理参数的相关性。采用Kaplan-Meier分析和考克斯比例风险模型评估术前梗阻对各期无病生存率的影响，术前梗阻63例（9.8%）（II期，n = 16; III期，n = 47）。多因素分析显示，术前梗阻与结肠癌患者术前癌胚抗原水平升高显著相关（OR = 3.59; P < 0.001），而与直肠癌患者术前分化差相关（OR = 3.99; P = 0.016）。术前肠梗阻是III期大肠癌的一个重要预后因素（P < 0.001），但在II期大肠癌中不是。多因素预后分析显示术前肠梗阻是III期大肠癌的独立预后因素。这一发现得到了结肠癌和直肠癌的单独分析的证实。术前肠梗阻与全身复发相关（P = 0.003），而与腹膜或局部复发无关。这些结果表明，术前肠梗阻可能预示III期结直肠癌患者的长期预后较差，并可能成为识别高危III期结直肠癌患者的潜在临床标志物。
Previous studies have suggested a detrimental prognostic effect of preoperative obstruction proximal to colorectal cancer (CRC). If such a detrimental effect is preserved in each stage of advanced (stage II or III) CRC, we can identify high-risk patients.We enrolled 641 patients with pathologically confirmed advanced CRC (stage II, n = 207; stage III, n = 434) who had undergone curative resection of the primary lesion. The association of preoperative obstruction with clinicopathologic parameters was evaluated. Kaplan-Meier analysis and Cox proportional hazard models were used to estimate the effect of preoperative obstruction on disease-free survival in each stage.Preoperative obstruction was seen in 63 patients (9.8%) (stage II, n = 16; stage III, n = 47). Multivariable analysis showed that preoperative obstruction was significantly associated with preoperative elevation of carcinoembryonic antigen level in patients with colon cancer (odds ratio = 3.59; P < 0.001), while it was correlated with poor differentiation in patients with rectal cancer (odds ratio = 3.99; P = 0.016). Preoperative obstruction was a significant prognostic factor in stage III CRC (P < 0.001), but not in stage II disease. Multivariable prognostic analysis showed that preoperative obstruction was a remnant independent prognostic factor in stage III CRC. This finding was confirmed by separate analyses of colon and rectal cancer. Preoperative obstruction was associated with systemic recurrence (P = 0.003) rather than peritoneal or local recurrence.These findings suggest that preoperative obstruction may predict worse long-term prognosis in patients with stage III CRC and may be a potential clinical marker to identify patients with high-risk stage III CRC.