Division of Colorectal surgery, Department of Surgery, University of California Irvine, Medical Center, Orange, California, USA.
Dis Colon Rectum. 2012 May;55(5):509-14. doi: 10.1097/DCR.0b013e3182420953.
Information about adenosquamous carcinoma of the colon and rectum is scarce because of its extremely low incidence.
The aim of this study was to examine the prognostic significance of a histological diagnosis of adenosquamous carcinoma in comparison with adenocarcinoma of the colon and rectum.
This study was retrospective in design.
California Cancer Registry data from 1994 through 2004 with follow-up through 2008 were analyzed.
Patients were included whose cancer of the colon and rectum, excluding the anus with a tumor histology of adenocarcinoma and adenosquamous carcinoma, was surgically treated.
The primary outcomes measured were histology-specific survival analyses (with the use of the Kaplan-Meier method), and overall and colorectal-specific mortality (with the use of multivariable Cox proportional hazards regression analyses).
A total of 111,263 adenocarcinoma and adenosquamous carcinoma of colon and rectal cancer cases were identified (adenocarcinoma, 99.91%; adenosquamous carcinoma, 0.09%). There was no significant difference in sex, age, race, and socioeconomic status between the 2 groups. The most common location of adenocarcinoma and adenosquamous carcinoma was the right and transverse colon. The adenosquamous carcinoma group was significantly associated with a higher rate of metastasis at the time of operation (adenosquamous carcinoma, 36.56% vs adenocarcinoma, 13.92%) and with poorly differentiated tumor grade (adenosquamous carcinoma, 65.96% vs adenocarcinoma, 19.74%) in comparison with the adenocarcinoma group. The median overall survival time was significantly greater in the adenocarcinoma group (82.4 months) in comparison with the adenosquamous carcinoma group (35.3 months). With the use of multivariable hazard regression analyses, adenosquamous carcinoma histology was independently associated with increased overall mortality (hazard ratio, 1.67) and colorectal-specific mortality (hazard ratio, 1.69) in comparison with adenocarcinoma.
This is one of the largest studies of adenosquamous carcinoma of the colon and rectum to date. This uncommon colorectal cancer subtype was associated with higher overall and colorectal-specific mortality in comparison with adenocarcinoma. Among colorectal cancer cases, adenosquamous carcinoma histology should be considered a poor prognostic feature.
由于腺鳞癌发病率极低，有关结直肠腺鳞癌的信息十分有限。
本研究旨在探讨腺鳞癌的组织学诊断与结直肠腺癌相比的预后意义。
本研究为回顾性设计。
加州癌症登记处 1994 年至 2004 年的数据，随访至 2008 年。
纳入的患者患有结直肠癌和直肠癌，肿瘤组织学为腺癌和腺鳞癌，经手术治疗。
主要观察指标为组织学特异性生存分析（采用 Kaplan-Meier 法）以及总死亡率和结直肠癌特异性死亡率（采用多变量 Cox 比例风险回归分析）。
共确定 111263 例结直肠腺癌和腺鳞癌病例（腺癌 99.91%；腺鳞癌 0.09%）。两组患者的性别、年龄、种族和社会经济地位无显著差异。腺癌和腺鳞癌最常见的部位为右半结肠和横结肠。腺鳞癌组在手术时转移的发生率明显高于腺癌组（腺鳞癌 36.56%，腺癌 13.92%），且肿瘤分化程度较差（腺鳞癌 65.96%，腺癌 19.74%）。腺癌组的中位总生存时间明显长于腺鳞癌组（82.4 个月 vs 35.3 个月）。采用多变量风险回归分析，与腺癌相比，腺鳞癌组织学与总死亡率（危险比 1.67）和结直肠癌特异性死亡率（危险比 1.69）的增加独立相关。
这是迄今为止最大的结直肠腺鳞癌研究之一。这种不常见的结直肠癌症亚型与腺癌相比，总死亡率和结直肠癌特异性死亡率更高。在结直肠癌病例中，腺鳞癌组织学应被视为预后不良的特征。
