Department of Surgery, Kitasato University School of Medicine, Kitasato 1-15-1, Minami-ku, Sagamihara, 252-0374, Kanagawa, Japan.
J Gastrointest Surg. 2011 Jan;15(1):120-9. doi: 10.1007/s11605-010-1379-4. Epub 2010 Nov 18.
In stage II colorectal cancer (CRC), high-risk patient selection is required, but no candidate markers have been elucidated. Our concern was whether anastomotic leakage (Lk) is a potential available clinicopathological factor for selecting high-risk stage II.
Two hundred seven patients with stage II CRC who underwent curative resection were analyzed. Clinical variables were tested for their relationship to survival.
The 5-year disease-free survival rate (DFS) was 87.0%. The univariable prognostic analyses indicated that Lk (P = 0.003) was the only significant factor. The multivariable prognostic analysis revealed that Lk remained to be potently independent [hazard ratio (HR), 4.21, P = 0.021), and the DFS was 58.3% in cases with Lk, while 88.7% in the counterpart. The multivariable logistic regression analysis revealed perioperative blood transfusion (P = 0.001) was independently associated with Lk. Intriguingly, Lk was closely associated with hematogenic recurrence (P = 0.003) rather than peritoneal or local recurrence. Although sustained increase of the serum C-reactive protein at 2 weeks after operation predicted poor prognosis, the mutitivariable analysis including the C-reactive protein level revealed that Lk still indicated the prognostic potential (HR, 3.70, P = 0.075).
The findings concluded that Lk may be a high risk for systemic recurrence in stage II CRC.
在 II 期结直肠癌（CRC）中，需要选择高危患者，但尚未阐明候选标志物。我们关注的是吻合口漏（Lk）是否是选择高危 II 期患者的潜在临床病理因素。
分析了 207 例接受根治性切除术的 II 期 CRC 患者。对临床变量进行了测试，以确定它们与生存的关系。
5 年无病生存率（DFS）为 87.0%。单变量预后分析表明，Lk（P=0.003）是唯一显著的因素。多变量预后分析显示，Lk 仍然是强有力的独立因素[风险比（HR），4.21，P=0.021]，Lk 组的 DFS 为 58.3%，而对照组为 88.7%。多变量逻辑回归分析显示围手术期输血（P=0.001）与 Lk 独立相关。有趣的是，Lk 与血行复发密切相关（P=0.003），而与腹膜或局部复发无关。虽然术后 2 周血清 C 反应蛋白持续升高预示预后不良，但包括 C 反应蛋白水平在内的多变量分析显示 Lk 仍具有预后潜力（HR，3.70，P=0.075）。
研究结果表明，Lk 可能是 II 期 CRC 全身复发的高危因素。
