Eisenberg B, Decosse J J, Harford F, Michalek J
Cancer. 1982 Mar 15;49(6):1131-4. doi: 10.1002/1097-0142(19820315)49:6<1131::aid-cncr2820490611>3.0.co;2-t.
For 1704 patients with large bowel cancer compiled by the Armed Forces Central Medical Registry, selected prognostic factors were related to five-year or longer survival. The majority of late deaths (those occurring after five years) resulted from cancer in the descending colon, sigmoid colon or rectum rather than from cancer in the right or transverse colon. For example, among all patients with cancer of the rectum, 15.4% of those with Dukes' B tumors and 10.9% of those with Dukes' C tumors died of rectal cancer between five and ten years after diagnosis. When late survival rates were compared, patients with right and transverse colon cancer (8 deaths/93 at risk) fared significantly better than those with left colon and rectal cancer (33 deaths/171 at risk; P = 0.01). Among patients with left-sided colon and rectal carcinoma, a further significant difference in late survival was found when stage of disease was considered: patients with Dukes' A cancers (3 deaths/47 at risk after five years) fared better than those with Dukes' C cancers (21 deaths/74 at risk) (P = 0.002). For Dukes' B and C stages of disease, patients with left colon and rectal cancer fared worse than those with right and transverse colon lesions after 60 months. Of all patients who died of large bowel cancer after five years, 69% had a recurrence of cancer by 60 months, and most late recurrences were located in the descending and sigmoid colon and in the rectum. These results show differences in survival after five years with respect to both site of cancer in the colon and stage of initial disease. Our findings indicate that many left-sided large bowel cancers have a slowly progressive natural history.
对于武装部队中央医疗登记处汇编的1704例大肠癌患者，选定的预后因素与五年或更长时间的生存率相关。大多数晚期死亡（发生在五年后）是由降结肠、乙状结肠或直肠癌引起的，而非右半结肠或横结肠癌。例如，在所有直肠癌患者中，15.4%的Dukes B期肿瘤患者和10.9%的Dukes C期肿瘤患者在诊断后五至十年死于直肠癌。比较晚期生存率时，右半结肠和横结肠癌患者（8例死亡/93例处于风险中）的情况明显好于左半结肠和直肠癌患者（33例死亡/171例处于风险中；P = 0.01）。在左侧结肠癌和直肠癌患者中，考虑疾病分期时发现晚期生存率存在进一步显著差异：Dukes A期癌症患者（5年后3例死亡/47例处于风险中）的情况好于Dukes C期癌症患者（21例死亡/74例处于风险中）（P = 0.002）。对于疾病的Dukes B期和C期，60个月后，左半结肠和直肠癌患者的情况比右半结肠和横结肠病变患者更差。在所有五年后死于大肠癌的患者中，69%在60个月时出现癌症复发，大多数晚期复发位于降结肠、乙状结肠和直肠。这些结果显示了结肠癌部位和初始疾病分期在五年后的生存率差异。我们的研究结果表明，许多左侧大肠癌具有缓慢进展的自然病程。
