Kang Sung Il, Kim Duck-Woo, Kwak Yoonjin, Lee Hye-Seung, Kim Min Hyun, Kim Myung Jo, Oh Heung-Kwon, Kang Sung-Bum
Department of Surgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea.
Department of Pathology, Seoul National University Bundang Hospital, Seongnam, South Korea.
Int J Colorectal Dis. 2018 Jun;33(6):719-726. doi: 10.1007/s00384-018-3031-9. Epub 2018 Mar 28.
Recently, several reports have suggested that tumor location serves as a prognostic biomarker in advanced colorectal cancer. However, the prognostic implication of tumor location in patients with early-stage colorectal cancer remains unclear. This study was aimed to examine the prognostic implication of tumor location in patients with early-stage colorectal cancer.
Patients with stage I and low-risk stage II colorectal cancer, treated with radical surgery in a hospital setting between May 2003 and September 2014, were retrospectively reviewed. Patients who underwent (neo) adjuvant chemotherapy and/or radiotherapy and whose microsatellite instability (MSI) status was lacked were excluded. Distal colon cancer was defined as tumors located from the splenic flexure colon to the sigmoid colon.
A total of 712 patients were included in this study. Of these patients, 23 (3.2%) had a recurrence at a median follow-up time of 46 months. The tumor recurrence rate was significantly low in patients with proximal colon cancer. In the multivariate analysis, tumors located in the distal colon or rectum (distal colon, hazard ratio [HR] 9.213, P = 0.035; rectum, HR 15.366, P = 0.009) and T3 tumors (HR 4.590, P = 0.017) were related to tumor recurrence. A higher prevalence of tumor recurrence was found in patients with two recurrence factors than those who had only one factor or none (P < 0.001).
Tumor location, as well as T stage, had prognostic implication in patients with early-stage colorectal cancer. Validation of our results is needed in a large cohort with genetic characterization.
最近，有几份报告表明肿瘤位置是晚期结直肠癌的一种预后生物标志物。然而，肿瘤位置对早期结直肠癌患者的预后影响仍不明确。本研究旨在探讨肿瘤位置对早期结直肠癌患者的预后影响。
回顾性分析2003年5月至2014年9月在一家医院接受根治性手术治疗的I期和低风险II期结直肠癌患者。排除接受过（新）辅助化疗和/或放疗以及微卫星不稳定性（MSI）状态未知的患者。远端结肠癌定义为从脾曲结肠至乙状结肠的肿瘤。
本研究共纳入712例患者。其中，23例（3.2%）在中位随访时间46个月时出现复发。近端结肠癌患者的肿瘤复发率显著较低。在多变量分析中，位于远端结肠或直肠的肿瘤（远端结肠，风险比[HR]9.213，P = 0.035；直肠，HR 15.366，P = 0.009）和T3肿瘤（HR 4.590，P = 0.017）与肿瘤复发相关。有两个复发因素的患者比只有一个因素或没有因素的患者肿瘤复发率更高（P < 0.001）。
肿瘤位置以及T分期对早期结直肠癌患者具有预后意义。需要在一个具有基因特征的大型队列中验证我们的结果。
