目的:在可切除的结直肠癌中,肿瘤部位与复发后病程和初次手术后预后的关系尚不清楚。这项研究调查了在I-III期结直肠癌中未经术前治疗的根治性切除术后原发肿瘤位置的预后影响。
方法:我们分析了2000-15年间在我院接受根治性切除术的3770例I-III期结直肠癌患者。我们将右侧结肠定义为盲肠,升结肠和横结肠,左侧结肠作为降结肠,乙状结肠和直肠乙状结肠交界处。根据肿瘤部位将患者分为三组:右侧结肠,左侧结肠和直肠。终点是总生存期,分期无复发生存率和复发后生存率,分别。
结果:I期左侧结肠癌患者的5年总生存率,右半结肠癌和直肠癌分别为98.2%、97.3%和97.2%,分别为(P=0.488)。II期左半结肠癌患者的5年总生存率,右半结肠癌和直肠癌分别为96.2,88.7和83.0(P=0.070).III期左半结肠癌患者的5年总生存率,右半结肠癌和直肠癌分别为88.7,83.0和80.2(P=0.001).I期左半结肠癌患者5年无复发生存率,右半结肠癌和直肠癌分别为95.1、94.5和90.6%(P=0.027)。II期左半结肠癌患者5年无复发生存率,右半结肠癌和直肠癌分别为85.2、90.2和76.1%,分别(P<0.001)。III期左半结肠癌患者的5年无复发生存率,右侧结肠癌和直肠癌分别为75.3、75.3和59.8%,分别(P<0.001)。校正临床因素后,与左侧结肠癌(HR1.29,95%CI1.03-1.63;P=0.025)和直肠癌(HR1.89,95%CI1.51-2.38;P<0.001)相比,右侧结肠癌具有更好的无复发生存率。在复发的患者中,与左侧结肠癌相比,右侧结肠癌与复发后的生存率显着相关(HR0.68,95%CI0.48-0.97;P=0.036),与直肠癌相比,复发后生存率下降(HR0.79,95%CI0.57-1.10;P=0.164)。
结论:在未经术前治疗的I-III期结直肠癌中,我们的结果表明,三个肿瘤部位(右侧结肠,左侧结肠或直肠)可能对无复发生存率和复发后生存率具有预后意义,而不是单打独斗。
OBJECTIVE: The relationship of tumour site with post-recurrence course and outcome after primary surgery in resectable colorectal cancer is unclear. This study investigated the prognostic impact of primary tumour location following radical resection without preoperative treatment in Stage I-III colorectal cancer.
METHODS: We analyzed 3770 patients with Stage I-III colorectal cancer who underwent curative resection at our hospital during 2000-15. We defined the right-sided colon as the cecum, ascending colon and transverse colon, and the left-sided colon as the descending colon, sigmoid and rectosigmoid junction. Patients were divided into three groups according to tumour site: right-sided colon, left-sided colon and rectum. Endpoints were overall survival, recurrence-free survival by stage and survival after recurrence, respectively.
RESULTS: The 5-year overall survival rates of patients with stage I left-sided colon cancer, right-sided colon cancer and rectal cancer were 98.2, 97.3 and 97.2%, respectively (P = 0.488). The 5-year overall survival rates of patients with Stage II left-sided colon cancer, right-sided colon cancer and rectal cancer were 96.2, 88.7 and 83.0, respectively (P = 0.070). The 5-year overall survival rates of patients with Stage III left-sided colon cancer, right-sided colon cancer and rectal cancer were 88.7, 83.0 and 80.2, respectively (P = 0.001). The 5-year recurrence-free survival rates of patients with Stage I left-sided colon cancer, right-sided colon cancer and rectal cancer were 95.1, 94.5 and 90.6% (P = 0.027). The 5-year recurrence-free survival rates of patients with Stage II left-sided colon cancer, right-sided colon cancer and rectal cancer were 85.2, 90.2 and 76.1%, respectively (P < 0.001). The 5-year recurrence-free survival rates of patients with Stage III left-sided colon cancer, right-sided colon cancer and rectal cancer were 75.3, 75.3 and 59.8%, respectively (P < 0.001). Right-sided colon cancer was significantly associated with better recurrence-free survival compared with left-sided colon cancer (HR 1.29, 95% CI 1.03-1.63; P = 0.025) and rectal cancer (HR 1.89, 95% CI 1.51-2.38; P < 0.001) after adjusting for clinical factors. Amongst patients with recurrence, right-sided colon cancer was significantly associated with poorer survival after recurrence compared with left-sided colon cancer (HR 0.68, 95% CI 0.48-0.97; P = 0.036), and showed a tendency towards poorer survival after recurrence compared with rectal cancer (HR 0.79, 95% CI 0.57-1.10; P = 0.164).
CONCLUSIONS: In Stage I-III colorectal cancer without preoperative treatment, our results suggest that the three tumour sites (right-sided colon, left-sided colon or rectum) may have prognostic significance for recurrence-free survival and survival after recurrence, rather than sidedness alone.