Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
Department of Gastroenterology, Kasugai Municipal Hospital, 1-1-1 Takaki-cho, Kasugai, 486-8510, Japan.
Int J Clin Oncol. 2018 Dec;23(6):1101-1111. doi: 10.1007/s10147-018-1307-2. Epub 2018 Jun 15.
Obstructive colorectal cancer (CRC) is an emergency situation with high morbidity and mortality, but long-term outcomes of stage II/III obstructive CRC remain unclear. The aim of this study was to evaluate prognostic factors, including colorectal obstruction.
Data were retrospectively reviewed from consecutive patients with stage II/III CRC who underwent curative surgery between January 2007 and December 2011 at two Japanese institutions. We analyzed overall survival (OS) and relapse-free survival (RFS), according to various prognostic factors including colorectal obstruction.
In total, 979 patients with stage II/III CRC were identified for this study. Among these 979 patients, 94 patients showed colorectal obstruction (9.6%). In both stage II and stage III CRCs, colorectal obstruction showed significantly poorer OS and RFS compared to non-obstruction (5-year OS, obstruction vs. non-obstruction, stage II: 65.9 vs. 86.5%, P = 0.002; stage III: 55.9 vs. 73.6%, P = 0.007) (5-year RFS, obstruction vs. non-obstruction, stage II: 59.2 vs. 77.8%, P = 0.008; stage III 31.3 vs. 56.3%, P = 0.001). Multivariate analysis demonstrated colorectal obstruction as a significant independent and poor prognostic factor in terms of both OS (hazard ratio (HR) 2.469; 95% CI 1.339-4.545; P = 0.004) and RFS (HR 1.992; 95% CI 1.160-3.425; P = 0.012) for stage II CRC, as well as pT4 stage. On multivariate analysis for stage III CRC, colorectal obstruction was a significant predictor of poor RFS (HR 1.626; 95% CI 1.070-2.469; P = 0.023), but not poor OS.
Colorectal obstruction is an independent poor prognostic factor for stage II CRC. Adjuvant chemotherapy might be feasible for stage II CRC with colorectal obstruction.
梗阻性结直肠癌（CRC）是一种发病率和死亡率均较高的紧急情况，但 II/III 期梗阻性 CRC 的长期预后仍不清楚。本研究旨在评估包括结直肠梗阻在内的预后因素。
本研究回顾性分析了 2007 年 1 月至 2011 年 12 月期间在日本的两家机构接受根治性手术的 II/III 期 CRC 连续患者的数据。我们根据包括结直肠梗阻在内的各种预后因素，分析了总生存期（OS）和无复发生存期（RFS）。
本研究共纳入 979 例 II/III 期 CRC 患者，其中 94 例出现结直肠梗阻（9.6%）。在 II 期和 III 期 CRC 中，结直肠梗阻的 OS 和 RFS 明显差于非梗阻（5 年 OS，梗阻 vs. 非梗阻，II 期：65.9% vs. 86.5%，P=0.002；III 期：55.9% vs. 73.6%，P=0.007）（5 年 RFS，梗阻 vs. 非梗阻，II 期：59.2% vs. 77.8%，P=0.008；III 期 31.3% vs. 56.3%，P=0.001）。多变量分析表明，结直肠梗阻是 OS（危险比（HR）2.469；95%置信区间（CI）1.339-4.545；P=0.004）和 RFS（HR 1.992；95%CI 1.160-3.425；P=0.012）的独立且不良预后因素，以及 pT4 期。对于 III 期 CRC 的多变量分析，结直肠梗阻是 RFS 不良的显著预测因素（HR 1.626；95%CI 1.070-2.469；P=0.023），但不是 OS 不良。
结直肠梗阻是 II 期 CRC 的独立不良预后因素。对于结直肠梗阻的 II 期 CRC，辅助化疗可能是可行的。
