Prognostic Implications of Extranodal Extension in Relation to Colorectal Cancer Location
Prognostic Implications of Extranodal Extension in Relation to Colorectal Cancer Location
复制标题
结直肠癌发生部位相关的结外扩散对预后的影响
DOI：
10.4143/crt.2018.392
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发表时间：
2019-07-01
影响因子：
4.6
通讯作者：
Kim, Jin Cheon
中科院分区：
文献类型：
--
作者：
Kim, Chan Wook;Kim, Jihun;Kim, Jin Cheon
目的结外延伸（ENE）与结肠癌和直肠癌的侵袭性密切相关。本研究评估了不同人群结肠癌和直肠癌患者中ENE的临床病理意义和预后影响。材料与方法对2003年1月至2011年12月在我院行根治性手术治疗的2346例结直肠癌患者的临床和组织学资料进行回顾性分析。结果在结肠癌和直肠癌中，tsene均与年龄较轻、肿瘤分期较晚、淋巴血管侵袭（LVI）和神经周围侵袭（PNI）相关。右结肠癌（36.9%）、左结肠癌（42.6%）和直肠（48.7%）癌症患者的ENE发生率差异显著（右vs左，p=0.037；左vs直肠，p=0.009）。ENE阴性结肠癌（80.5%）、ENE阴性直肠癌（77.4%）、ENE阳性结肠癌（68.6%）和ENE阳性直肠癌（64.2%）患者根据ENE状态和原发肿瘤部位的5年无病生存率（DFS）差异有统计学意义（p < 0.001）。多因素分析显示，肿瘤分期晚期、ENE、LVI、PNI、有无辅助化疗是影响结直肠癌患者DFS降低的独立预后因素。结论ene与结直肠癌的侵袭性密切相关，其发生频率从右结肠到左结肠再到直肠呈递增趋势。与肿瘤位置无关，ENE状态是结直肠癌患者DFS的重要独立预测因子。ENE可能与远端位置的结直肠癌更相关。
PurposeExtranodal extension (ENE) is closely associated with the aggressiveness of both colon and rectal cancer. This study evaluated the clinicopathologic significance and prognostic impact of ENE in separate populations of patients with colon and rectal cancers.Materials and MethodsThe medical records of 2,346 patients with colorectal cancer (CRC) who underwent curative surgery at our institution between January 2003 and December 2011 were clinically and histologically reviewed.ResultsENE was associated with younger age, advanced tumor stage, lymphovascular invasion (LVI), and perineural invasion (PNI) in both colon and rectal cancer. ENE rates differed significantly in patients with right colon (36.9%), left colon (42.6%), and rectal (48.7%) cancers (right vs. left, p=0.037; left vs. rectum, p=0.009). The 5-year disease-free survival (DFS) rate according to ENE status and primary tumor site differed significantly in patients with ENE-negative colon cancer (80.5%), ENE-negative rectal cancer (77.4%), ENE-positive colon cancer (68.6%), and ENE-positive rectal cancer (64.2%) (p < 0.001). Multivariate analysis showed that advanced tumor stage, ENE, LVI, PNI, and absence of adjuvant chemotherapy were independently prognostic of reduced DFS in colon and rectal cancer patients.ConclusionENE is closely associated with the aggressiveness of colon and rectal cancers, with its frequency increasing from the right colon to the left colon to the rectum. ENE status is a significant independent predictor of DFS in CRC patients irrespective of tumor location. ENE might be more related with distally located CRC.