Tominaga T, Sakabe T, Koyama Y, Hamano K, Yasutomi M, Takahashi T, Kodaira S, Kato T, Ogawa N
Tokyo Metropolitan Komagome Hospital, Tokyo, Japan.
Cancer. 1996 Aug 1;78(3):403-8. doi: 10.1002/(SICI)1097-0142(19960801)78:3<403::AID-CNCR4>3.0.CO;2-K.
The prognostic factors and natural history of recurrence in patients with colorectal carcinoma who underwent curative resection and no other therapy were analyzed.
The object of analysis was the potentially curative resection only subgroup in the randomized clinical trial (RCT) that we performed. Cox's proportional hazards model was used mainly to analyze recurrence rates during the first 5 years after surgery.
The analysis was performed on a subgroup of the RCT (279 patients with colon carcinoma and 293 patients with rectal carcinoma). Five-year disease free survival rates were 76.3% and 56.5% for colon and rectal carcinomas, respectively. The prognostic factors for recurrence for colon carcinoma patients were different from those with rectal carcinoma. For colon carcinoma, only Dukes stage was significant, whereas for rectal carcinoma, Dukes stage, age, location of the tumor, and serosal and venous invasion by cancer cells were prognostic factors. Log-transformed disease free survival rates were linear in Dukes Stage B and biphasic in Dukes Stage C for both colon and rectal carcinoma. The two phases in Dukes Stage C intersected at 2.85 and 3.04 years, respectively. The annual hazard value was high for the first 3 years in both colon and rectal carcinoma.
We conclude that follow-up of patients with colorectal carcinoma who undergo potentially curative resection is of particular importance in the first 3 years after surgery. Furthermore, the usefulness of adjuvant chemotherapy can be adequately evaluated from data yielded during this postoperative period.
对接受根治性切除且未接受其他治疗的结直肠癌患者的预后因素及复发自然史进行了分析。
分析对象为我们所进行的随机临床试验（RCT）中仅行潜在根治性切除的亚组。主要采用Cox比例风险模型分析术后前5年的复发率。
对RCT的一个亚组（279例结肠癌患者和293例直肠癌患者）进行了分析。结肠癌和直肠癌的5年无病生存率分别为76.3%和56.5%。结肠癌患者的复发预后因素与直肠癌患者不同。对于结肠癌，只有Dukes分期具有显著性，而对于直肠癌，Dukes分期、年龄、肿瘤位置以及癌细胞的浆膜和静脉侵犯均为预后因素。结肠癌和直肠癌的对数转换无病生存率在Dukes B期呈线性，在Dukes C期呈双相性。Dukes C期的两个阶段分别在2.85年和3.04年相交。结肠癌和直肠癌术后前3年的年度风险值均较高。
我们得出结论，对接受潜在根治性切除的结直肠癌患者进行随访在术后前3年尤为重要。此外，辅助化疗的有效性可从术后这一时期产生的数据中得到充分评估。
