Anastomotic Leakage Contributes to the Risk for Systemic Recurrence in Stage II Colorectal Cancer
Anastomotic Leakage Contributes to the Risk for Systemic Recurrence in Stage II Colorectal Cancer
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DOI：
10.1007/s11605-010-1379-4
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发表时间：
2011-01-01
影响因子：
3.2
通讯作者：
Watanabe, Masahiko
中科院分区：
文献类型：
--
作者：
Katoh, Hiroshi;Yamashita, Keishi;Watanabe, Masahiko
在II期结直肠癌（CRC）中，需要选择高风险患者，但尚未阐明候选标记物。我们关注的是吻合口漏（Lk）是否是一个潜在的临床病理学因素，选择高风险的II期。207例II期CRC患者接受根治性切除进行了分析。临床变量与生存率的关系进行了检验，5年无病生存率（DFS）为87.0%。单因素预后分析显示Lk（P = 0.003）是唯一有意义的因素。多因素预后分析显示，Lk仍是潜在的独立因素[危险比（HR），4.21，P = 0.021]，Lk组的DFS为58.3%，而对照组为88.7%。多因素Logistic回归分析显示围手术期输血（P = 0.001）与Lk独立相关。有趣的是，Lk与血液源性复发密切相关（P = 0.003），而不是腹膜或局部复发。尽管术后2周血清C反应蛋白持续升高预示预后不良，但包括C反应蛋白水平在内的多因素分析显示，Lk仍预示预后（HR为3.70，P = 0.075），提示Lk可能是II期结直肠癌全身复发的高危因素。
In stage II colorectal cancer (CRC), high-risk patient selection is required, but no candidate markers have been elucidated. Our concern was whether anastomotic leakage (Lk) is a potential available clinicopathological factor for selecting high-risk stage II.Two hundred seven patients with stage II CRC who underwent curative resection were analyzed. Clinical variables were tested for their relationship to survival.The 5-year disease-free survival rate (DFS) was 87.0%. The univariable prognostic analyses indicated that Lk (P = 0.003) was the only significant factor. The multivariable prognostic analysis revealed that Lk remained to be potently independent [hazard ratio (HR), 4.21, P = 0.021), and the DFS was 58.3% in cases with Lk, while 88.7% in the counterpart. The multivariable logistic regression analysis revealed perioperative blood transfusion (P = 0.001) was independently associated with Lk. Intriguingly, Lk was closely associated with hematogenic recurrence (P = 0.003) rather than peritoneal or local recurrence. Although sustained increase of the serum C-reactive protein at 2 weeks after operation predicted poor prognosis, the mutitivariable analysis including the C-reactive protein level revealed that Lk still indicated the prognostic potential (HR, 3.70, P = 0.075).The findings concluded that Lk may be a high risk for systemic recurrence in stage II CRC.