Chiang Jy Ming, Hsieh Pao Shiu, Chen Jinn Shiun, Tang Reiping, You Jeng Fu, Yeh Chien Yuh
Division of colorectal surgery, Department of surgery, Chang Gung Memorial Hospital, Lin-Kou medical center, and College of Medicine, Chang Gung University, No,5, Fu-Hsing St, Kuei-Shan, Tao-Yuan 333, Taiwan.
World J Surg Oncol. 2014 Jun 30;12:197. doi: 10.1186/1477-7819-12-197.
Rectal cancer patients have a higher incidence of pulmonary metastases than those with colon cancer. This study aimed to examine the effects of rectal cancer level on recurrence patterns in rectal cancer patients.
Patients with T3/T4 rectal cancers who underwent surgery between 2002 and 2006 were recruited in this study. All the patients were followed up on until death. Recurrence patterns and survival rates were calculated in relation to clinical variables.
There were 884 patients were enrolled in this study. Patients with low-rectal cancer had significantly worse five-year overall survival (OS) and disease-free survival (DFS) rates (47.25% and 44.07%, respectively) than patients with mid-rectal (63.46% and 60.22%, respectively) and upper-rectal cancers (73.91% and 71.87%, respectively). The level of the tumor (P <0.001), nodal status (P <0.001), tumor invasion depth (P <0.001), and tumor differentiation (P = 0.047, P = 0.015) significantly affected the surgical outcomes related to OS and DFS in the univariate and multivariate analyses. Furthermore, the level of the rectal cancer was a significant risk factor (hazard ratio 1.114; 95% CI, 1.074 to 1.161; P <0.001) for local recurrence, lung metastases, bone metastases, and systemic lymph node metastases. Significantly higher incidence rates of bone (53.8%) and brain metastases (22.6%) after initial lung metastases rather than initial liver metastases (14.8% and 2.9%, respectively) were also observed.
For rectal cancer patients who underwent surgical resection, the rectal cancer level significantly affected surgical outcomes including rates and patterns of distant metastases.
直肠癌患者肺转移的发生率高于结肠癌患者。本研究旨在探讨直肠癌病变位置对直肠癌患者复发模式的影响。
本研究纳入了2002年至2006年间接受手术治疗的T3/T4期直肠癌患者。所有患者均随访至死亡。根据临床变量计算复发模式和生存率。
本研究共纳入884例患者。低位直肠癌患者的五年总生存率（OS）和无病生存率（DFS）（分别为47.25%和44.07%）显著低于中位直肠癌患者（分别为63.46%和60.22%）和高位直肠癌患者（分别为73.91%和71.87%）。在单因素和多因素分析中，肿瘤位置（P<0.001）、淋巴结状态（P<0.001）、肿瘤浸润深度（P<0.001）和肿瘤分化程度（P = 0.047，P = 0.015）对与OS和DFS相关的手术结局有显著影响。此外，直肠癌位置是局部复发、肺转移、骨转移和全身淋巴结转移的显著危险因素（风险比1.114；95%CI，1.074至1.161；P<0.001）。还观察到，与初始肝转移（分别为14.8%和2.9%）相比，初始肺转移后骨转移（53.8%）和脑转移（22.6%）的发生率显著更高。
对于接受手术切除的直肠癌患者，直肠癌位置显著影响手术结局，包括远处转移的发生率和模式。
