Burgundy Digestive Cancer Registry, University of Burgundy, University Hospital Dijon, Dijon, France.
Colorectal Dis. 2013 Sep;15(9):1100-6. doi: 10.1111/codi.12268.
Little is known about patterns of recurrence in obstructing colon cancer (OCC) at a population level. The aim of this study was to determine the risk of recurrence following potentially curative surgery in OCC compared with that in uncomplicated colon cancer (CC).
Data were obtained from the population-based digestive cancer registry of Burgundy (France). Local and distant failure rates were calculated using actuarial methods. A multivariate analysis was performed using a Cox model.
Obstructing colon cancer represented 8.5% of all colon cancers resected with curative intent (n = 3375). The 5-year cumulative local recurrence rate was 14.2% for OCC and 7.6% for nonobstructing CC (P = 0.003). In the multivariate analysis, obstruction was an independent risk factor for local recurrence [hazard ratio 1.53 (1.01-2.34), P = 0.047]. The risk of local recurrence increased with advanced stage and age at diagnosis. The 5-year cumulative rate for distant metastases was also higher in OCC than in nonobstructing CC (36.1 vs 23.1%; P < 0.001). The relative risk of distant metastasis was borderline significant in the multivariate analysis [hazard ratio 1.25 (0.99-1.59), P = 0.057]. Stage at diagnosis, macroscopic type of growth, period of diagnosis and sex were also significant prognostic factors. Age and subsite were not significant in the multivariate analysis.
It is possible to conduct special surveys in population-based registries to determine the recurrence rate of CC. Recurrence remains a substantial problem and is more frequent in OCC than in nonobstructing CC. Efforts must be made to diagnose CC earlier. Mass screening is a promising approach.
在人群水平上，阻塞性结肠癌（OCC）的复发模式知之甚少。本研究旨在确定与非阻塞性结肠癌（CC）相比，OCC 患者在接受潜在根治性手术后的复发风险。
数据来自勃艮第（法国）基于人群的消化癌症登记处。使用生存分析法计算局部和远处失败率。使用 Cox 模型进行多变量分析。
OCC 占所有接受根治性切除的结肠癌的 8.5%（n=3375）。OCC 的 5 年累积局部复发率为 14.2%，而非阻塞性 CC 为 7.6%（P=0.003）。在多变量分析中，梗阻是局部复发的独立危险因素[风险比 1.53（1.01-2.34），P=0.047]。局部复发的风险随疾病分期和诊断时年龄的增加而增加。OCC 的远处转移 5 年累积率也高于非阻塞性 CC（36.1%比 23.1%；P<0.001）。远处转移的相对风险在多变量分析中具有边缘显著性[风险比 1.25（0.99-1.59），P=0.057]。诊断时的分期、生长的大体类型、诊断时期和性别也是重要的预后因素。年龄和部位在多变量分析中无显著性意义。
在基于人群的登记处进行专门调查以确定 CC 的复发率是可行的。复发仍然是一个重大问题，OCC 比非阻塞性 CC 更常见。必须努力更早地诊断 CC。大规模筛查是一种很有前途的方法。
