Incidence and patterns of recurrence following curative resection for colorectal carcinoma
Incidence and patterns of recurrence following curative resection for colorectal carcinoma
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DOI：
10.1007/bf02055676
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发表时间：
1997-01-01
影响因子：
3.9
通讯作者：
Gordon, PH
中科院分区：
文献类型：
--
作者：
Obrand, DI;Gordon, PH
目得：本研究旨在确定结直肠癌根治性切除术后复发的发生率和模式，并确定哪些变量对预测结果有意义。方法：回顾性分析了1975年至1992年由一名外科医生手术的524例患者。记录的变量包括年龄、性别、位置、大体形态学、组织学、每个原发灶的分期以及初次手术时穿孔和直接延伸的证据。记录总生存率和复发模式。结果：总复发率为27.9%。吻合口复发率为11.7%。直肠病变的吻合口复发率高于结肠病变（20.3%比6.2%; P = 0.001）。14.4%的患者发生远处转移，结肠癌为13.9%，直肠癌为15.5%。吻合口复发的平均时间为16.2个月，而远端疾病为22.9个月。T1、2、N 0、M0病变的复发率为17.6%，T3、N 0、M0为23.4%，T1、2、3、N1、M0为43.7%（P = 0.001）。诊断复发后未接受任何干预的患者平均存活28个月。接受姑息治疗的患者平均存活39个月。24%的患者接受了再次切除治疗，其中47%的患者平均存活80个月;死于疾病的患者平均存活53个月。复发的阳性预测因素包括病变部位（直肠与结肠）、分期、邻近器官的侵犯和穿孔的存在。年龄、性别、分化程度、粘蛋白分泌和大体形态在本研究中未发现是预测因素。结论：直肠癌术后复发率高于结肠癌。在那些有可能再次切除的患者中，高达50%的患者可以长期生存。了解复发的模式和易患复发的特征可以指导医生进行积极但更具选择性的辅助治疗，并建议在随访中进行有针对性的监测。
PURPOSE: This study was designed to determine incidence and patterns of recurrence after curative resection of colorectal carcinoma and to determine which variables are significant in predicting outcome. METHOD: A retrospective review of 524 patients operated on by one surgeon from 1975 to 1992 was conducted. Variables recorded included age, gender, location, gross morphology, histology, stage of each primary and evidence of perforation and direct extension at time of original operation. Overall survival and pattern of recurrence were documented. RESULTS: Overall recurrence rate was 27.9 percent. Anastomotic recurrence rate was 11.7 percent. Anastomotic recurrences were higher for rectal than colon lesions (20.3 vs. 6.2 percent; P = 0.001). Distant metastases developed in 14.4 percent of patients, 13.9 percent for colon carcinoma and 15.5 percent for rectal carcinoma. Average time for anastomotic recurrence was 16.2 months vs. 22.9 months for distant disease. T1,2,N0,M0 lesions had a 17.6 percent recurrence rate, T3,N0,M0 was 23.4 percent, and T1,2,3,N1,M0 was 43.7 percent (P = .001). Patients who did not undergo any intervention after diagnosis of recurrence survived an average of 28 months. Those who received palliative treatment survived an average of 39 months. Twenty-four percent of patients had reresection for cure, and 47 percent of these patients were alive at a mean of 80 months; those who died of their disease did so at an average of 53 months. Positive predictive factors for recurrence include site of lesion (rectum vs. colon), stage, invasion of contiguous organs, and presence of perforation. Age, gender, degree of differentiation, mucin secretion, and gross morphology were not found to be predictive factors in this study. CONCLUSIONS: Recurrence after resection for rectal carcinoma is higher than after colon carcinoma. In those patients in whom reresection is possible, up to 50 percent may have longterm survival. Understanding patterns of recurrence and features that predispose to them may guide the physician in aggressive but more selective adjuvant therapy and recommendations for targeted surveillance in follow-up.