Choo Jeong-Min, Baek Se-Jin, Kwak Jung-Myun, Kim Jin, Kim Seon-Hahn
Department of Surgery, Korea University College of Medicine, Seoul, Korea.
Ann Surg Treat Res. 2020 Jul;99(1):37-43. doi: 10.4174/astr.2020.99.1.37. Epub 2020 Jun 29.
Clinically suspected T4 stage colon cancer from a preoperative exam is often diagnosed as T3 stage colon cancer pathologically after surgery, raising concerns about understaging. The aims of this study were to compare the survival of clinical T3 and T4 colon cancer patients who had received a pathologic T3 stage diagnosis postoperatively.
Patients who were diagnosed with pathologic T3 stage colon cancer postoperatively were reviewed. Patients with clinically suspected T3 or T4 stage cancer on preoperative exam were enrolled in the study. We compared patient demographics and survival of the cT3 and cT4 groups.
Out of the 536 patients with pT3 colon cancer, 503 patients were cT3 (93.8%) and 33 patients were cT4 (6.2%) preoperatively. The most common reason for suspected clinical T4 stage cancer was free perforation (78.8%). There were no statistically significant differences between the 5-year overall survival and the total 5-year disease-free survival (DFS) between the cT3 and cT4 groups; however, local recurrence was significantly higher in the cT4 group (local 5-year DFS: 98.6% vs. 84.0%, P < 0.001). Multivariate analysis showed cT stage was associated with local recurrence, but the association was not statistically significant (P = 0.056).
Preoperative clinically suspected T4 stage colon cancer showed inferior local recurrence despite a postoperative pathologic diagnosis of T3 stage cancer. It is necessary to address the shortcomings of pathologic exams in the matter of the understaging of T4 colon cancer, and to reinforce the treatment for local control in patients with cT4 colon cancer.
术前检查临床怀疑为T4期的结肠癌患者术后病理诊断常为T3期结肠癌，这引发了对分期不足的担忧。本研究的目的是比较术后病理诊断为T3期的临床T3和T4期结肠癌患者的生存率。
回顾术后诊断为病理T3期结肠癌的患者。纳入术前临床怀疑为T3或T4期癌症的患者。我们比较了cT3组和cT4组患者的人口统计学特征和生存率。
在536例pT3结肠癌患者中，术前503例为cT3（93.8%），33例为cT4（6.2%）。临床怀疑为T4期癌症的最常见原因是游离穿孔（78.8%）。cT3组和cT4组之间的5年总生存率和5年无病生存率（DFS）无统计学显著差异；然而，cT4组的局部复发率显著更高（局部5年DFS：98.6%对84.0%，P<0.001）。多因素分析显示cT分期与局部复发有关，但该关联无统计学显著性（P=0.056）。
术前临床怀疑为T4期的结肠癌尽管术后病理诊断为T3期癌症，但局部复发情况较差。有必要解决T4期结肠癌分期不足方面病理检查的缺陷，并加强对cT4期结肠癌患者的局部控制治疗。
