Lin Po-Yen, Chiang Jy-Ming, Huang Hsin-Yun, You Jeng-Fu, Chiang Sum-Fu, Hsieh Pao-Shiu, Yeh Chien-Yuh, Tang Rei-Ping
Department of Surgery, Chang Gung Memorial Hospital, Cha-Yi Medical Center, Cha-Yi, Taiwan.
Division of Colon and Rectal Surgery, Department of Surgery, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan.
Int J Colorectal Dis. 2018 Sep;33(9):1235-1240. doi: 10.1007/s00384-018-3106-7. Epub 2018 Jun 21.
Clinicopathologic factors relating to developing metachronous colorectal cancer (CRC) have been reported. However, the effects of different diagnostic intervals on these risk factors required further analysis.
This retrospective study comprised 14,481 patients diagnosed from January 1995 to December 2012. Metachronous CRC was defined as the occurrence of a second colorectal cancer at least 1 year post-operatively.
A total of 153 (1.06%) patients developed metachronous CRCs during the follow-up. Significantly higher rates of developing metachronous cancer occurred in male patients (1.2 vs 0.9%), patients with synchronous CRC (2.0 vs 1.0%), and patients with a positive family history of CRC (1.4 vs 0.9%). Pertaining to diagnostic intervals related to clinicopathological features, more severe staging was significant in the diagnostic interval between 2 and 3 years (35 vs 7.7%, 20.6%, 17.5%, P = .01) compared with other intervals. Male patients were more frequently detected to have CRC within 3 years compared with females (53.1 vs 29.1%, P = .005). For a diagnostic interval ≧ 5 years, a significantly higher rate of metachronous CRC located at the right colon was observed than that located at the left colon (36.6 vs 19.7%, p = 0.03).
We evinced that a diagnostic interval between 2 and 3 years was a key time for metachronous CRC diagnosis with worse staging distribution. Based on current findings, we recommend the stratification of metachronous CRCs into diagnostic intervals of 1-2, 2-3, and ≧ 3 years, as they exhibit significantly different characteristics.
已有报道与异时性结直肠癌（CRC）发生相关的临床病理因素。然而，不同诊断间隔对这些危险因素的影响需要进一步分析。
这项回顾性研究纳入了1995年1月至2012年12月期间诊断的14481例患者。异时性CRC定义为术后至少1年发生的第二例结直肠癌。
共有153例（1.06%）患者在随访期间发生了异时性CRC。男性患者（1.2%对0.9%）、同时性CRC患者（2.0%对1.0%）以及有CRC家族史阳性的患者（1.4%对0.9%）发生异时性癌症的比例显著更高。关于与临床病理特征相关的诊断间隔，与其他间隔相比，2至3年的诊断间隔中更严重分期具有显著意义（35%对7.7%、20.6%、17.5%，P = 0.01）。与女性相比，男性患者在3年内更频繁地被检测出患有CRC（53.1%对29.1%，P = 0.005）。对于诊断间隔≥5年，观察到位于右半结肠的异时性CRC发生率显著高于位于左半结肠的发生率（36.6%对19.7%，p = 0.03）。
我们证明2至3年的诊断间隔是异时性CRC诊断的关键时期，且分期分布更差。基于当前研究结果，我们建议将异时性CRC按1 - 2年、2 - 3年和≥3年的诊断间隔进行分层，因为它们表现出显著不同的特征。
