Takahashi T, Kato T, Kodaira S, Koyama Y, Sakabe T, Tominaga T, Hamano K, Yasutomi M, Ogawa N
Colorectal Cancer Chemotherapy Study Group, Japan.
Am J Clin Oncol. 1996 Aug;19(4):408-15. doi: 10.1097/00000421-199608000-00019.
One thousand two hundred fifty-four cases (610 colonic and 644 rectal cancers resected during 2 years from 1984 and followed up for more than 5 years) were entered from 140 institutions in Japan and analyzed by means of Cox's proportional hazards model. The analyzed pathologic variables were the size and depth of invasion, Dukes' stage, venous invasion, lymphatic permeation, and other clinical features, such as the sex and age of the patient and location of the tumor. The extent of dissection, serum carcinoembryonic antigen (CEA) level, and the presence or absence of adjuvant chemotherapy were also analyzed. Adjuvant chemotherapy consisted of three arms for both colonic and rectal cancers. For colonic cancer, arm I was a combination of i.p. (intraportal) and i.v. mitomycin C (MMC) + p.o. 5-fluorouracil (5-FU); arm II was i.v. MMC + p.o. 5-FU; and arm III was surgery only. For rectal cancer, arm IV was a combination of i.a. (inferior mesenteric artery) and i.v. MMC + p.o. 5-FU; arm V was i.v. MMC + p.o. 5-FU; and arm VI was surgery only. As for the factors affecting the disease-free survival of the patient, multivariate analysis disclosed nodal involvement, venous invasion, an elevated CEA level, and the lower part of the rectum. The effect of adjuvant chemotherapy on the patient's survival was proven for rectal cancer but not for colonic cancer. We conclude that these factors should be considered in setting the stage of tumor pre- and postoperatively.
从日本140家机构纳入了1254例病例（1984年起2年内切除的610例结肠癌和644例直肠癌，并随访5年以上），并采用Cox比例风险模型进行分析。分析的病理变量包括肿瘤大小、浸润深度、Dukes分期、静脉侵犯、淋巴管浸润以及其他临床特征，如患者的性别、年龄和肿瘤位置。还分析了清扫范围、血清癌胚抗原（CEA）水平以及辅助化疗的有无。结肠癌和直肠癌的辅助化疗均分为三个组。结肠癌方面，I组为门静脉内（i.p.）联合静脉注射丝裂霉素C（MMC）+口服5-氟尿嘧啶（5-FU）；II组为静脉注射MMC+口服5-FU；III组仅行手术。直肠癌方面，IV组为肠系膜下动脉内（i.a.）联合静脉注射MMC+口服5-FU；V组为静脉注射MMC+口服5-FU；VI组仅行手术。至于影响患者无病生存的因素，多因素分析显示有淋巴结受累、静脉侵犯、CEA水平升高以及直肠下段。辅助化疗对直肠癌患者生存的影响得到证实，但对结肠癌患者未得到证实。我们得出结论，在术前和术后设定肿瘤分期时应考虑这些因素。
