Lim Ji Ha, Lee Woo Yong, Yun Seong Hyeon, Kim Hee Cheol, Cho Yong Beom, Huh Jung Wook, Park Yoon Ah, Shin Jung Kyong
Department of Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea.
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Front Oncol. 2022 Jun 6;12:914299. doi: 10.3389/fonc.2022.914299. eCollection 2022.
Obstruction in colon cancer is a well-known risk factor for worse oncologic outcomes. However, studies on differences in survival of patients with incomplete obstructive colon cancer (IOCC) by tumor location are insufficient. Thus, the aim of this study was to compare oncologic outcomes between IOCC and non-obstructive colon cancer (NOCC) according to tumor location.
From January 2010 to December 2015, a total of 2,004 patients diagnosed with stage II or stage III colon adenocarcinoma who underwent elective colectomy were included (IOCC, = 405; NOCC, = 1,599). Incomplete obstruction was defined as a state in which colonoscopy could not pass through the cancer lesion but did not require emergent surgery, stent insertion, or stoma formation because the patient was asymptomatic without problem in bowel preparation. Kaplan-Meier method and log-rank tests were used to compare survival between IOCC and NOCC. Multivariable analysis was performed to determine which factors affected survivals.
Stage III IOCC patients showed significantly lower overall survival (OS) and recurrence-free survival (RFS). Stage II IOCC patients and stage III NOCC patients had similar survival curves. IOCC patients with tumors on the right side showed worse OS than other patients. In multivariable analysis, incomplete obstruction was an independent risk factor for worse OS and RFS in all stages. Tumor located at the right side in stage III was an independent risk factor for RFS (HR: 1.40, = 0.030).
Patients with IOCC showed significantly worse survival outcomes than those with NOCC. Stage II IOCC patients and stage III NOCC patients showed similar survival. Patients with stage III IOCC located at the right side showed significantly worse oncologic outcomes than those located at the left side. These results confirm that prognosis is different depending on the presence of incomplete obstruction and the location of the tumor, even in the same stage.
结肠癌梗阻是肿瘤学预后较差的一个众所周知的危险因素。然而，关于不完全梗阻性结肠癌（IOCC）患者生存情况按肿瘤位置差异的研究并不充分。因此，本研究的目的是根据肿瘤位置比较IOCC和非梗阻性结肠癌（NOCC）的肿瘤学预后。
纳入2010年1月至2015年12月期间共2004例诊断为II期或III期结肠腺癌并接受择期结肠切除术的患者（IOCC，n = 405；NOCC，n = 1599）。不完全梗阻定义为结肠镜无法通过癌灶，但由于患者无症状且肠道准备无问题而无需急诊手术、置入支架或造口的状态。采用Kaplan-Meier法和对数秩检验比较IOCC和NOCC之间的生存率。进行多变量分析以确定哪些因素影响生存率。
III期IOCC患者的总生存期（OS）和无复发生存期（RFS）显著较低。II期IOCC患者和III期NOCC患者的生存曲线相似。右侧有肿瘤的IOCC患者的OS比其他患者更差。在多变量分析中，不完全梗阻是所有分期中OS和RFS较差的独立危险因素。III期右侧肿瘤是RFS的独立危险因素（HR：1.40，P = 0.030）。
IOCC患者的生存结局明显比NOCC患者差。II期IOCC患者和III期NOCC患者的生存情况相似。右侧的III期IOCC患者的肿瘤学预后明显比左侧患者差。这些结果证实，即使在同一分期，预后也因不完全梗阻的存在和肿瘤位置而异。
