Cho Yong Beom, Chun Ho-Kyung, Yun Hae Ran, Kim Hee Cheol, Yun Seong Hyeon, Lee Woo Yong
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine.
Hepatogastroenterology. 2009 Sep-Oct;56(94-95):1335-40.
BACKGROUND/AIMS: This study analyzed the patients who died of recurrent colorectal cancer and determined the clinicopathologic indicators that were associated with the survival time.
The study included 282 patients who died of recurrent colorectal cancer after resection. The clinicopathologic findings were compared between 162 patients who died within 3 years after resection (the short-term survival group) and 120 patients who died more than 3 years after resection (the long-term survival group). Multivariate analysis was performed to determine the independent factors correlated with the timing of death.
When compared with the long-term survival group, the short-term survival group was characterized by a tumor size >5 cm (51.2% in the short-term survival group vs. 39.2% in the long-term survival group), poorly differentiated tumor (13.3% vs. 0.9%), invasion through the muscularis propria (98.8% vs. 88.3%), positive lymphatic invasion (43.2% vs. 20.8%), positive vascular invasion (34.0% vs. 16.7%), positive perineural invasion (17.9% vs. 8.3%), extended lymph node metastasis and Dukes' stage C disease (80.9% vs. 60.8%). The mean survival time was significantly influenced by the histologic grade, the depth of wall invasion, the presence of lymphatic or vascular invasion, the level of lymph node metastasis and the Dukes' stage. On multivariate analysis, however, histologic grade was the only independent factor associated with the survival time.
The histological grade was the only significant factor influencing the survival time after resection of colorectal cancer. The patients with poorly differentiated adenocarcinoma frequently died of recurrence within 3 years after colorectal resection.
背景/目的：本研究分析了死于复发性结直肠癌的患者，并确定了与生存时间相关的临床病理指标。
该研究纳入了282例切除术后死于复发性结直肠癌的患者。比较了162例切除术后3年内死亡的患者（短期生存组）和120例切除术后3年以上死亡的患者（长期生存组）的临床病理结果。进行多变量分析以确定与死亡时间相关的独立因素。
与长期生存组相比，短期生存组的特征为肿瘤大小>5 cm（短期生存组为51.2%，长期生存组为39.2%）、肿瘤分化差（13.3%对0.9%）、侵犯固有肌层（98.8%对88.3%）、淋巴管侵犯阳性（43.2%对20.8%）、血管侵犯阳性（34.0%对16.7%）、神经周围侵犯阳性（17.9%对8.3%）、广泛淋巴结转移和杜克分期C期疾病（80.9%对60.8%）。平均生存时间受组织学分级、壁层侵犯深度、淋巴管或血管侵犯情况、淋巴结转移水平和杜克分期的显著影响。然而，多变量分析显示，组织学分级是与生存时间相关的唯一独立因素。
组织学分级是影响结直肠癌切除术后生存时间的唯一重要因素。低分化腺癌患者在结直肠癌切除术后3年内常死于复发。
