Chok Kenneth S H, Law Wai Lun
Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam Road, Hong Kong SAR, China.
World J Surg. 2007 Jul;31(7):1485-90. doi: 10.1007/s00268-007-9089-0. Epub 2007 May 18.
Data on the prognostic factors of survival and recurrence in patients with colorectal cancers confined to the bowel wall (T1 and T2) are limited. The aim of the present study was to determine factors that might predict the survival and recurrence of patients who had T1 and T2 colorectal cancers.
All patients with T1 or T2 colorectal cancers who underwent resection in the Department of Surgery, University of Hong Kong Medical Centre, from 1996 to 2004 were included. Analysis was made from the prospectively collected database. Predictive factors for lymph node metastasis and prognostic factors were analyzed.
A total of 265 patients (144 men) with the median age of 71 years (range: 33-93 years) were included. Seventy-two patients had T1 cancers (rectal cancer n = 44; colon cancer n = 28; p = 0.89) and 193 patients suffered from T2 cancer (rectal n = 120; colon cancer n = 73). The overall incidence of lymph node metastasis was 12.7% (5.6% for T1 cancer and 14.5% for T2 cancer; p = 0.021). The presence of lymphovascular permeation was the only independent factor associated with a higher incidence of lymph node metastasis on multivariate analysis (odds ratio: 1.48, 95% CI: 1.44-13.47, p = 0.009). There were no significant differences in disease-free 5-year survival (T1 = 84.6%; T2 = 81.1%) and 5-year cancer-specific survival in patients with T1 and T2 tumors (T1 = 90.2%; T2 = 90.6%). Patients with lymph node metastasis had a significantly shorter disease-free 5-year survival (p < 0.001) and 5-year cancer-specific survival (p = 0.002) when compared with those having a negative lymph node status. Cox proportional hazards model analysis showed that lymph node status was the only significant independent factor predicting cancer-specific survival (hazard ratio: 3.52, 95% CI: 1.60-7.71, p = 0.002) and disease-free survival (hazard ratio: 3.42, 95% CI: 1.75-6.69, p < 0.001).
Presence of lymphovascular permeation would have a significant higher chance of lymph node metastasis. Positive lymph node status was predictive of poorer survival in patients with T1 or T2 colorectal cancers. For those cancers with positive lymphovascular permeation, radical surgery is recommended.
关于局限于肠壁（T1和T2）的结直肠癌患者生存和复发的预后因素的数据有限。本研究的目的是确定可能预测T1和T2期结直肠癌患者生存和复发的因素。
纳入1996年至2004年在香港大学医学中心外科接受手术切除的所有T1或T2期结直肠癌患者。分析来自前瞻性收集的数据库。分析淋巴结转移的预测因素和预后因素。
共纳入265例患者（144例男性），中位年龄71岁（范围：33 - 93岁）。72例患者为T1期癌（直肠癌44例；结肠癌28例；p = 0.89），193例患者为T2期癌（直肠癌120例；结肠癌73例）。淋巴结转移的总体发生率为12.7%（T1期癌为5.6%，T2期癌为14.5%；p = 0.021）。多因素分析显示，淋巴管浸润是与淋巴结转移发生率较高相关的唯一独立因素（比值比：1.48，95%可信区间：1.44 - 13.47，p = 0.009）。T1和T2期肿瘤患者的5年无病生存率（T1 = 84.6%；T2 = 81.1%）和5年癌症特异性生存率无显著差异（T1 = 90.2%；T2 = 90.6%）。与淋巴结阴性的患者相比，有淋巴结转移的患者5年无病生存率（p < 0.001）和5年癌症特异性生存率显著缩短（p = 0.002）。Cox比例风险模型分析显示，淋巴结状态是预测癌症特异性生存（风险比：3.52，95%可信区间：1.60 - 7.71，p = 0.002）和无病生存（风险比：3.42，95%可信区间：1.75 - 6.69，p < 0.001）的唯一显著独立因素。
存在淋巴管浸润时淋巴结转移的可能性显著更高。淋巴结阳性状态可预测T1或T2期结直肠癌患者的较差生存。对于那些有淋巴管浸润阳性的癌症，建议行根治性手术。
