The John Goligher Colorectal Unit, The General Infirmary at Leeds, Leeds, West Yorkshire, UK.
Colorectal Dis. 2011 Dec;13(12):1390-4. doi: 10.1111/j.1463-1318.2010.02507.x.
Data on the prognostic factors for survival in patients with locally advanced, node-negative colon cancer are limited. This study aimed to determine which factors might predict survival in patients with Dukes' B (T3 or T4, N0) colon cancer.
One hundred and eighty (93 male; median age 75 [range, 38-96] years) consecutive patients who had resection of a primary Dukes' B (on final histopathological analysis) colonic cancer between 1998 and 2003 were studied. No patient received neoadjuvant chemotherapy. Multivariate Cox regression modelling was used to assess the prognostic value of variables. Median follow up was 85 (60-125) months.
Thirteen (7%) patients had a perforation at presentation. The median distance from tumour to the nearest longitudinal resection margin was 6 (0.3-27) cm. One hundred and twenty-four (69%) patients had a lymph node yield of 12 or more nodes. Actual 5-year survival was 59%. On multivariate regression analysis, tumour perforation (perforation vs no perforation, 5-year survival, 23%vs 61%; hazard ratio (HR), 3.7; 95% confidence interval (CI), 1.6-8.4; P = 0.002), tumour-to-margin distance (< 5 cm vs ≥ 5 cm, 48%vs 65%; HR, 1.7; 95% CI, 1.1-2.7; P = 0.039) and older age (≥ 75 years vs < 75 years, 45%vs 72%; HR, 3; 95% CI, 1.8-5; P < 0.001) were independent significant variables.
A lymph node yield of 12 or more nodes is not a significant prognostic factor for survival after resection of Dukes' B colonic cancer. Patients with tumour perforation or limited resection have worse prognosis.
局部晚期、淋巴结阴性结肠癌患者的生存预后因素数据有限。本研究旨在确定哪些因素可能预测 Dukes'B（T3 或 T4，N0）结肠癌患者的生存情况。
对 1998 年至 2003 年间连续 180 例（93 名男性；中位年龄 75 岁[范围，38-96 岁]）接受原发性 Dukes'B（最终组织病理学分析）结肠癌症切除术的患者进行研究。无患者接受新辅助化疗。采用多变量 Cox 回归模型评估变量的预后价值。中位随访时间为 85（60-125）个月。
13（7%）例患者在就诊时发生穿孔。肿瘤到最近的纵向切缘的距离中位数为 6（0.3-27）cm。124（69%）例患者的淋巴结产量为 12 个或更多。实际 5 年生存率为 59%。多变量回归分析显示，肿瘤穿孔（穿孔与无穿孔，5 年生存率分别为 23%和 61%；危险比（HR），3.7；95%置信区间（CI），1.6-8.4；P=0.002）、肿瘤-切缘距离（<5cm 与≥5cm，48%与 65%；HR，1.7；95%CI，1.1-2.7；P=0.039）和年龄较大（≥75 岁与<75 岁，45%与 72%；HR，3；95%CI，1.8-5；P<0.001）是独立的显著变量。
淋巴结产量为 12 个或更多个并不是 Dukes'B 结肠癌症切除术后生存的显著预后因素。肿瘤穿孔或有限切除的患者预后较差。
