Konishi Tsuyoshi, Watanabe Toshiaki, Kishimoto Junji, Kotake Kenjiro, Muto Tetsuichiro, Nagawa Hirokazu
Department of Surgical Oncology, University of Tokyo, Tokyo, Japan.
Gut. 2007 Jun;56(6):863-8. doi: 10.1136/gut.2006.109157. Epub 2007 Jan 9.
Colorectal carcinoids are often described as low-grade malignant. However, no study has compared the survival between patients with colorectal carcinoids and those with carcinomas, in a large series. In addition, no global consensus has been established on the crucial determinants of metastasis in colorectal carcinoids.
To determine the predictive factors for metastasis in colorectal carcinoids and clarify their prognosis compared with adenocarcinomas.
Data of all patients diagnosed as having colorectal carcinoids were extracted from a large nationwide database of colorectal tumours, the Multi-Institutional Registry of Large-Bowel Cancer in Japan, for the period from 1984 to 1998. Risk factors for lymph node (LN) metastases and distant metastases were analysed among those who were undergoing surgery, by univariate and multivariate analysis. Cancer-specific survival was also compared between patients with colorectal carcinoids and those with adenocarcinomas registered in the same period.
Among the 90 057 cases of colorectal tumours that were diagnosed, a total of 345 cases of carcinoids were identified, including 247 colorectal carcinoids of those undergoing surgery. Risk factors for LN metastasis were tumour size >/=11 mm and lymphatic invasion, whereas those for distant metastasis were tumour size >/=21 mm and venous invasion. Colorectal carcinoids without these risk factors exhibited no LN metastasis or distant metastasis. Cancer-specific survival of patients with colorectal carcinoids without metastasis was better than that of those with adenocarcinomas. However, the survival was similar between carcinoids and adenocarcinomas if the tumours had LN metastasis or distant metastasis.
The presence of metastasis in colorectal carcinoids could lead to survival that is as poor as in adenocarcinomas. Tumours </=10 mm and without lymphatic invasion could be curatively treated by local resection, but others would need radical LN dissection.
结直肠类癌常被描述为低度恶性。然而，尚无研究在大量病例中比较结直肠类癌患者与癌患者的生存率。此外，关于结直肠类癌转移的关键决定因素尚未达成全球共识。
确定结直肠类癌转移的预测因素，并阐明与腺癌相比其预后情况。
从日本全国性大型结直肠肿瘤数据库“多机构大肠癌登记处”中提取1984年至1998年期间所有诊断为结直肠类癌患者的数据。对接受手术的患者进行单因素和多因素分析，以分析淋巴结转移和远处转移的危险因素。同时比较结直肠类癌患者与同期登记的腺癌患者的癌症特异性生存率。
在90057例诊断为结直肠肿瘤的病例中，共识别出345例类癌，其中247例为接受手术的结直肠类癌。淋巴结转移的危险因素为肿瘤大小≥11mm和淋巴管侵犯，而远处转移的危险因素为肿瘤大小≥21mm和静脉侵犯。无这些危险因素的结直肠类癌未发生淋巴结转移或远处转移。无转移的结直肠类癌患者的癌症特异性生存率优于腺癌患者。然而，如果肿瘤发生淋巴结转移或远处转移，类癌和腺癌的生存率相似。
结直肠类癌发生转移会导致与腺癌一样差的生存率。肿瘤≤10mm且无淋巴管侵犯的可通过局部切除治愈，但其他患者则需要根治性淋巴结清扫。
