Patterns of metastasis in colon and rectal cancer.
Patterns of metastasis in colon and rectal cancer.
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DOI：
10.1038/srep29765
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发表时间：
2016-07-15
影响因子：
4.6
通讯作者：
Hemminki K
中科院分区：
文献类型：
--
作者：
Riihimäki M;Hemminki A;Sundquist J;Hemminki K
转移性结肠癌和直肠癌的流行病学调查是具有挑战性的，因为癌症登记很少记录转移部位。我们使用基于人群的方法来评估结肠癌和直肠癌的转移扩散。49，096例结直肠癌患者来自瑞典全国癌症登记处。从国家患者登记处和死亡原因登记处确定转移部位。直肠癌更常转移到胸部器官（OR = 2.4）和神经系统（1.5），较少发生在腹膜内（0.3）。与一般腺癌相比，粘液腺癌和印戒腺癌更常在腹膜内转移（3.8 [结肠]/3.2 [直肠]），较少转移至肝脏（0.5/0.6）。肺转移常与神经系统转移同时发生，而腹膜转移常与卵巢和胸膜转移同时收载。在诊断时分期较低的直肠癌患者中，胸部转移几乎与肝转移一样常见。结直肠癌孤立性转移患者的生存期在5至19个月之间，取决于T或N分期。结肠癌和直肠癌之间的转移模式明显不同。这些知识应该有助于临床医生识别需要额外监测的患者，并为进一步研究转移机制提供见解。
Investigating epidemiology of metastatic colon and rectal cancer is challenging, because cancer registries seldom record metastatic sites. We used a population based approach to assess metastatic spread in colon and rectal cancers. 49,096 patients with colorectal cancer were identified from the nationwide Swedish Cancer Registry. Metastatic sites were identified from the National Patient Register and Cause of Death Register. Rectal cancer more frequently metastasized into thoracic organs (OR = 2.4) and the nervous system (1.5) and less frequently within the peritoneum (0.3). Mucinous and signet ring adenocarcinomas more frequently metastasized within the peritoneum compared with generic adenocarcinoma (3.8 [colon]/3.2 [rectum]), and less frequently into the liver (0.5/0.6). Lung metastases occurred frequently together with nervous system metastases, whereas peritoneal metastases were often listed with ovarian and pleural metastases. Thoracic metastases are almost as common as liver metastases in rectal cancer patients with a low stage at diagnosis. In colorectal cancer patients with solitary metastases the survival differed between 5 and 19 months depending on T or N stage. Metastatic patterns differ notably between colon and rectal cancers. This knowledge should help clinicians to identify patients in need for extra surveillance and gives insight to further studies on the mechanisms of metastasis.