Wong Siu Kin C, Jalaludin Bin B, Morgan Matthew J, Berthelsen Angela S, Morgan Ann, Gatenby Andrew H, Fulham Stephen B
South Western Sydney Colorectal Tumor Group, Sydney South West Area Health Service, Sydney, Australia.
Dis Colon Rectum. 2008 Feb;51(2):223-30. doi: 10.1007/s10350-007-9094-2. Epub 2007 Dec 21.
Patients who have an emergency operation for colorectal cancer have poorer long-term survival outcomes compared with elective patients. This study was designed to define the role of tumor pathology as a basis for the differences in survival outcomes.
There were 1,537 elective and 286 emergency patients who had an operation for bowel cancer from 1997 to 2003. Tumor pathology and survival data collected prospectively for these patients were compared by modes of presentation.
Excluding 30-day mortality, emergency patients as a whole had a five-year all-cause survival rate of 39.2 percent compared with 64.7 percent for elective patients P<0.0001 they also had more advanced Dukes C and D tumors (P<0.0001). The rates of early T1 and T2 cancers were 4.7 percent for the emergency and 25 percent for the elective group. Emergency cases had more lymph node-positive patients and N2 patients (57.1 vs. 41.8 percent and 26.6 vs. 15.9 percent, respectively; P<0.0001). Curatively resected emergency colon patients again had more advanced Dukes staged tumors (P<0.0001) with a five-year survival rate of 51.6 percent compared with 75.6 percent for elective patients P<0.0001. On stage-for-stage analysis, the survival rates for curatively resected Dukes B and C colon cancers remained worse for emergency patients (P=0.003 and P=0.0002, respectively). Both emergency Dukes B and C groups had more T4 cases (21.5 vs. 10.6 percent; P=0.017 and 26.4 vs. 15 percent; P=0.016, respectively).
Advanced tumor pathology is a basis for poor long-term survival in emergency colorectal cancers.
与择期手术患者相比，因结直肠癌接受急诊手术的患者长期生存结局较差。本研究旨在确定肿瘤病理学在生存结局差异方面所起的作用。
1997年至2003年期间，有1537例择期手术患者和286例急诊手术患者接受了肠癌手术。通过手术方式对这些患者前瞻性收集的肿瘤病理学和生存数据进行比较。
排除30天死亡率后，急诊患者总体五年全因生存率为39.2%，而择期患者为64.7%（P<0.0001）。急诊患者中 Dukes C期和D期肿瘤也更多（P<0.0001）。急诊组早期T1和T2期癌症的发生率为4.7%，择期组为25%。急诊病例中淋巴结阳性患者和N2期患者更多（分别为57.1%对41.8%和26.6%对15.9%；P<0.0001）。接受根治性切除的急诊结肠癌患者再次出现更多Dukes分期较晚的肿瘤（P<0.0001），其五年生存率为51.6%，而择期患者为75.6%（P<0.0001）。在逐期分析中，接受根治性切除的Dukes B期和C期结肠癌急诊患者的生存率仍然较低（分别为P=0.003和P=0.0002）。急诊Dukes B期和C期组的T4病例均更多（分别为21.5%对10.6%；P=0.017和26.4%对15%；P=0.016）。
晚期肿瘤病理学是急诊结直肠癌患者长期生存不佳的一个原因。
