Emslie J, Beart R, Mohiuddin M, Marks G
Department of Surgery, Kaiser Permanente Medical Center, Los Angeles, California, USA.
Am Surg. 1998 Oct;64(10):958-61.
The hypothesis of this study was that the position of rectal cancer within the circumference of the rectum influences mortality. Tumor position was prospectively documented in 181 patients with rectal carcinoma by two examiners. The results were analyzed for correlation to survival using the Lifetest model and for multivariate correlation using the Cox regression model. An anterior tumor location was present in 43 patients and was found to have a significantly higher survival rate than other positions. Two-thirds of anterior tumors were of pathologically favorable Dukes' stages. Fifty-five patients had posterior tumors with decreased survival rates, two-thirds of which were of unfavorable stages. Circumferential position in 61 patients was most predictive of poorer outcome, with a relative risk of death being increased by 4.6 times (P = 0.014) and a 5-year survival rate of 68.8 per cent; 85 per cent of these tumors were of pathologically unfavorable stages. The 5-year survival rate for the whole group, which included 181 patients with all histopathological stages except those with distant metastases at presentation, was 78.5 per cent. This ranking of survival rates was found to be consistent in each category with the postoperatively determined Dukes' stage, which carried a prognostic significance of P = 0.0001. We conclude that tumor position is a significant indicator of prognosis available before surgery for rectal cancer.
本研究的假设是直肠癌在直肠圆周内的位置会影响死亡率。两名检查人员前瞻性地记录了181例直肠癌患者的肿瘤位置。使用寿命检验模型分析结果与生存率的相关性，并使用Cox回归模型分析多变量相关性。43例患者存在肿瘤位于前方的情况，发现其生存率明显高于其他位置。三分之二的前方肿瘤在病理上处于有利的Dukes分期。55例患者有后方肿瘤，生存率降低，其中三分之二处于不利分期。61例患者的圆周位置最能预测预后较差，死亡相对风险增加4.6倍（P = 0.014），5年生存率为68.8%；这些肿瘤中85%在病理上处于不利分期。包括181例除就诊时已有远处转移外所有组织病理学分期的患者的整个组的5年生存率为78.5%。发现这种生存率排名在每个类别中都与术后确定的Dukes分期一致，其预后意义为P = 0.0001。我们得出结论，肿瘤位置是直肠癌术前可用的预后重要指标。
