初始复发部位对结直肠癌根治术后预后的影响：一项回顾性队列研究。

Influence of the initial recurrence site on prognosis after radical surgery for colorectal cancer: a retrospective cohort study.

机构信息

Department of Radiology, the Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Centre, Kunming, 650118, China.

Department of Oncology, Dazhou Central Hospital, Dazhou, 635000, Sichuan, China.

出版信息

World J Surg Oncol. 2023 Apr 27;21(1):137. doi: 10.1186/s12957-023-03015-8.

DOI:10.1186/s12957-023-03015-8

PMID:37101165

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10134640/

Abstract

BACKGROUND & AIMS: In this retrospective study, we aimed to elucidate how the initial recurrence site influences the post-recurrence survival (PRS) after the curative resection of colorectal cancer.

PATIENTS AND METHODS

We collected samples from patients with stage I-III colorectal adenocarcinoma who were admitted to Yunnan Cancer Hospital from January 2008 to December 2019. Four hundred and six patients who developed recurrence after radical resection were included. The cases were classified according to the original site of recurrence as follows: liver metastases (n = 98), lung metastases (n = 127), peritoneum (n = 32), other individual organ (n = 69), two or more organs or sites (n = 49), and local recurrence (n = 31). Kaplan-Meier survival curves were used to compare the PRS of patients with different initial sites of recurrence. The influence of the initial recurrence site on PRS was analyzed using the Cox proportional hazards model.

RESULTS

The 3-year PRS of simple liver metastasis was 54.04% (95% CI, 45.46%-64.24%), and the 3-year PRS of simple lung metastasis was 50.05% (95% CI, 42.50%-58.95%). No significant difference was observed between simple liver metastasis or simple lung metastasis and local recurrence with a 3-year PRS of 66.99% (95% CI, 53.23%-84.32%). The 3-year PRS for peritoneal metastases was 25.43% (95% CI, 14.76%-43.82%), and the 3-year PRS for two or more organ sites was 34.84% (95% CI, 24.16%-50.24%). The peritoneal (hazard ratio [HR], 1.75; 95% CI, 1.10-2.79; P = 0.0189) and metastasis to two or more organs or sites (HR, 1.59; 95% CI, 1.05-2.43; P = 0.0304) were PRS-independent adverse prognostic factors.

CONCLUSION

The prognosis of patients with peritoneum and multiple organs or sites recurred was poor. This study suggests early monitoring of peritoneal and multiple organ or site recurrence after surgery. This part of patients should receive comprehensive treatment as early as possible to improve their prognosis.

摘要

背景与目的

本回顾性研究旨在阐明结直肠癌根治性切除术后初始复发部位如何影响复发后的生存（PRS）。

患者与方法

我们收集了 2008 年 1 月至 2019 年 12 月期间在云南省肿瘤医院接受治疗的 I-III 期结直肠腺癌患者的样本。纳入了 406 例根治性切除术后复发的患者。根据复发的原始部位将病例分为以下几类：肝转移（n=98）、肺转移（n=127）、腹膜转移（n=32）、其他单个器官（n=69）、两个或更多器官或部位（n=49）和局部复发（n=31）。采用 Kaplan-Meier 生存曲线比较不同初始复发部位患者的 PRS。使用 Cox 比例风险模型分析初始复发部位对 PRS 的影响。

结果

单纯肝转移的 3 年 PRS 为 54.04%（95%CI，45.46%-64.24%），单纯肺转移的 3 年 PRS 为 50.05%（95%CI，42.50%-58.95%）。单纯肝转移或单纯肺转移与局部复发的 3 年 PRS（66.99%，95%CI，53.23%-84.32%）无显著差异。腹膜转移的 3 年 PRS 为 25.43%（95%CI，14.76%-43.82%），两个或更多器官部位转移的 3 年 PRS 为 34.84%（95%CI，24.16%-50.24%）。腹膜转移（风险比[HR]，1.75；95%CI，1.10-2.79；P=0.0189）和转移至两个或更多器官或部位（HR，1.59；95%CI，1.05-2.43；P=0.0304）是 PRS 无关的不良预后因素。