Pietra N, Sarli L, Thenasseril B J, Costi R, Sansebastiano G, Peracchia A
Institute of General Surgery, University of Parma, School of Medicine, Italy.
Hepatogastroenterology. 1998 Sep-Oct;45(23):1573-8.
BACKGROUND/AIMS: Duke's staging is still the most widely used parameter in the estimation of risk for local recurrence in patients with colorectal neoplasia. The aim of this study is to identify biological determinants that may be of use in segregating patients with similarly staged tumors into groups with different risk of local recurrence.
Ninety-eight patients who had undergone curative resection for colorectal cancer between 1989 and 1991 were prospectively studied. Statistical analysis of clinical and pathologic variables was carried out using a Cox multivariate proportional hazard model.
Dukes stage and DNA ploidy were the only significantly predictive variables for local recurrence. In particular, the factors increasing local recurrence risk were seen to be the presence of lymph node metastases and aneuploid status. In the absence of both of these negative prognostic factors the risk of local recurrence is practically nil, in the presence of just one it reaches 16% and in the presence of both it rises to over 40%.
The results of this study indicate that the presence of an aneuploid tumor with positive lymph nodes places patients at a higher risk of local recurrence, and calls for post-operative adjuvant therapy and intensive follow-up.
背景/目的：在评估结直肠肿瘤患者局部复发风险时，杜克分期仍是应用最广泛的参数。本研究旨在确定生物学决定因素，这些因素可能有助于将分期相似的肿瘤患者分为局部复发风险不同的组。
对1989年至1991年间接受结直肠癌根治性切除术的98例患者进行前瞻性研究。使用Cox多变量比例风险模型对临床和病理变量进行统计分析。
杜克分期和DNA倍体是局部复发的唯一显著预测变量。特别是，增加局部复发风险的因素是存在淋巴结转移和非整倍体状态。在不存在这两个不良预后因素的情况下，局部复发风险几乎为零；仅存在其中一个因素时，风险达到16%；同时存在这两个因素时，风险升至40%以上。
本研究结果表明，存在伴有阳性淋巴结转移的非整倍体肿瘤会使患者局部复发风险更高，因此需要术后辅助治疗和强化随访。
