需要紧急手术的大肠梗阻患者的复发和结肠癌特异性死亡：竞争风险分析。

Recurrence and colon cancer-specific death in patients with large bowel obstruction requiring urgent operation: a competing risks analysis.

机构信息

Colorectal Surgical Unit, Concord Repatriation General Hospital, Sydney, NSW, Australia.

Department of Surgery, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.

出版信息

Colorectal Dis. 2021 Oct;23(10):2604-2618. doi: 10.1111/codi.15807. Epub 2021 Jul 23.

DOI:10.1111/codi.15807

PMID:34252253

Abstract

AIM

Clinical presentation with large bowel obstruction has been proposed as a predictor of poor long-term oncological outcomes after resection for colorectal cancer. This study examines the association between obstruction and recurrence and cancer-specific death after resection for colon cancer.

METHOD

Consecutive patients who underwent resection for colon cancer between 1995 and 2014 were drawn from a prospectively recorded hospital database with all surviving patients followed for at least 5 years. The outcomes of tumour recurrence and colon cancer-specific death were assessed by competing risks multivariable techniques with adjustment for potential clinical and pathological confounding variables.

RESULTS

Recurrence occurred in 271 of 1485 patients who had a potentially curative resection. In bivariate analysis, obstruction was significantly associated with recurrence [hazard ratio (HR) 2.23, CI 1.52-3.26, p < 0.001] but this association became nonsignificant after adjustment for confounders (HR 1.53, CI 0.95-2.46, p = 0.080). Colon cancer-specific death occurred in 238 of 295 patients who had a noncurative resection. Obstruction was not significantly associated with cancer-specific death (HR 1.02, CI 0.72-1.45, p = 0.903). In patients who had a noncurative resection, the competing risks incidence of colon cancer-specific death was not significantly greater in obstructed than in unobstructed patients (HR 1.02, CI 0.72-1.45, p = 0.903).

CONCLUSION

Whilst the immediate clinical challenge of an individual patient presenting with large bowel obstruction must be addressed by the surgeon, the patient's long-term oncological outcomes are unrelated to obstruction per se.

摘要

目的

有研究提出，结直肠癌切除术后出现大肠梗阻的临床表现与较差的长期肿瘤学预后相关。本研究旨在探讨结肠癌切除术后梗阻与肿瘤复发及癌症特异性死亡的相关性。

方法

从一个前瞻性记录的医院数据库中提取 1995 年至 2014 年间接受结肠癌切除术的连续患者，所有存活患者均随访至少 5 年。采用竞争风险多变量技术评估肿瘤复发和结肠癌特异性死亡的结果，并对潜在的临床和病理混杂因素进行调整。

结果

在接受潜在根治性切除术的 1485 例患者中，有 271 例发生复发。在单变量分析中，梗阻与复发显著相关（风险比[HR] 2.23，95%CI 1.52-3.26，p<0.001），但在调整混杂因素后，这种相关性变得无统计学意义（HR 1.53，95%CI 0.95-2.46，p=0.080）。在接受非根治性切除术的 295 例患者中，有 238 例发生结肠癌特异性死亡。梗阻与癌症特异性死亡无显著相关性（HR 1.02，95%CI 0.72-1.45，p=0.903）。在接受非根治性切除术的患者中，梗阻患者和未梗阻患者的结肠癌特异性死亡竞争风险发生率无显著差异（HR 1.02，95%CI 0.72-1.45，p=0.903）。