Newland R C, Dent O F, Chapuis P H, Bokey E L
Department of Anatomical Pathology, Concord Hospital, Sydney, Australia.
Cancer. 1993 Sep 1;72(5):1536-42. doi: 10.1002/1097-0142(19930901)72:5<1536::aid-cncr2820720508>3.0.co;2-u.
A lack of comprehensive information exists on the nature, incidence, and prognostic significance of known residual tumor in colorectal cancer patients treated by bowel resection. This study aims to provide this information.
A prospective series of 1766 consecutive patients from the Concord Hospital Colorectal Cancer Registry (Concord, Australia) was used for the analysis. Residual tumor was defined as distant metastases diagnosed clinically or pathologically or tumor demonstrated histologically in a line of resection. The pathologic study was highly standardized. Patient follow-up ranged from 6 months to 20.5 years. Survival analysis was by the Kaplan-Meier method. Multivariate models were examined using Cox proportional hazards regression.
The prevalence of residual tumor was 20.9% and the median survival was 11.6 months. In 4.5%, tumor transection alone occurred, 14.5% had distant metastases alone, and 1.9% had both. The difference in survival between the first two groups was at marginal statistical significance (P = 0.076). When each of these two groups was compared with the third group, significant differences were noticed (P = 0.001 and P = 0.004, respectively). Five of 14 pathology variables examined had a significant effect on survival using univariate analysis. On multivariate analysis only tumor transection and distant metastases had significant independent effects.
Known residual tumor was common in this series: one in five resections. Survival studies show that tumor transection, as defined, is a valid criterion for residual tumor. Survival is significantly reduced when tumor transection and distant metastases both are present. These findings should be heeded when staging colorectal cancer and when stratifying patients for postoperative adjuvant therapy.
对于接受肠道切除术的结直肠癌患者，已知残留肿瘤的性质、发生率及预后意义缺乏全面信息。本研究旨在提供这些信息。
对澳大利亚康科德医院结直肠癌登记处连续的1766例患者进行前瞻性分析。残留肿瘤定义为临床或病理诊断的远处转移或在切除线上组织学证实的肿瘤。病理研究高度标准化。患者随访时间为6个月至20.5年。采用Kaplan-Meier法进行生存分析。使用Cox比例风险回归检验多变量模型。
残留肿瘤的发生率为20.9%，中位生存期为11.6个月。4.5%的患者仅出现肿瘤横断，14.5%的患者仅出现远处转移，1.9%的患者两者均有。前两组的生存差异具有边际统计学意义（P = 0.076）。当将这两组分别与第三组进行比较时，发现有显著差异（分别为P = 0.001和P = 0.004）。单因素分析中，所检查的14个病理变量中有5个对生存有显著影响。多因素分析显示，只有肿瘤横断和远处转移具有显著的独立影响。
在本系列研究中，已知残留肿瘤很常见：每五次切除中就有一次。生存研究表明，所定义的肿瘤横断是残留肿瘤的有效标准。当同时存在肿瘤横断和远处转移时，生存率会显著降低。在对结直肠癌进行分期以及对患者进行术后辅助治疗分层时，应注意这些发现。
