Luo Dakui, Shan Zezhi, Liu Qi, Cai Sanjun, Ma Yanlei, Li Qingguo, Li Xinxiang
Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
J Cancer. 2021 Jan 15;12(6):1616-1622. doi: 10.7150/jca.52165. eCollection 2021.
Tumor size has an effect on decision making for the treatment rectal cancer. Transanal local excision can be selected to remove rectal cancer with favorable histopathological features. It is generally recognized that the risk of lymph node involvement and distant metastases increases as the tumor enlarges. However, the majority of the studies classified patients into two groups using concrete value as a cutoff point. The coarse classification was not sufficient to reveal a correlation between the tumor size and lymph node status or distant metastases across the full range of sizes examined. Between 1988 and 2015, a total of 77,746 patients were diagnosed with first primary rectal cancer who had not received neoadjuvant therapy. These subjects were identified using the Surveillance, Epidemiology and End Results (SEER) database. The association between tumor size, lymph node status, distant metastases and cancer-specific mortality was investigated. Tumor size was examined as a continuous (1-30 mm) and categorical variable (11 size groups; 10-mm intervals). A non-linear correlation between increasing tumor size and the prevalence of lymph node involvement was observed, while a near-positive correlation between tumor size and distant metastases was presented. In addition, the 5-year and 10-year rates of rectal cancer-specific mortality were increased as the tumor enlarged. For small tumors (under 30 mm), a positive correlation was noted between tumor size and lymph node involvement. The clinical value of the tumor size should be reevaluated by exact classification.
肿瘤大小对直肠癌的治疗决策有影响。可选择经肛门局部切除术来切除具有良好组织病理学特征的直肠癌。一般认为，随着肿瘤增大，淋巴结受累及远处转移的风险会增加。然而，大多数研究使用具体数值作为截断点将患者分为两组。这种粗略的分类不足以揭示在所检查的整个肿瘤大小范围内肿瘤大小与淋巴结状态或远处转移之间的相关性。1988年至2015年期间，共有77746例首次诊断为原发性直肠癌且未接受新辅助治疗的患者。这些受试者是使用监测、流行病学和最终结果（SEER）数据库识别出来的。研究了肿瘤大小、淋巴结状态、远处转移与癌症特异性死亡率之间的关联。将肿瘤大小作为连续变量（1 - 30毫米）和分类变量（11个大小组；间隔10毫米）进行检查。观察到肿瘤大小增加与淋巴结受累患病率之间存在非线性相关性，同时肿瘤大小与远处转移之间呈现近似正相关。此外，随着肿瘤增大，直肠癌特异性死亡率的5年和10年发生率增加。对于小肿瘤（30毫米以下），肿瘤大小与淋巴结受累之间存在正相关。应通过精确分类重新评估肿瘤大小的临床价值。
