Reasonable Follow Up Interval of Colonoscopy for Resected Stage I Colorectal Cancer Patient

根除性手術後的第一期大腸癌病患合理的大腸鏡檢查追蹤間格

林岳辰(Yueh-Chen Lin) ； 江支銘(Jy-Ming Chiang) ； 陳進勛(Jinn-Shiun Chen) ； 唐瑞平(Reiping Tang) ； 張簡俊榮(Chung-Rong Changchien) ； 游耀東(Yau-TongYou) ； 謝寶秀(Pao-Shiu Hsieh) ； 蔡文司(Wen-Sy Tsai) ； 洪欣園(Hsin-Yuan Hung) ； 游正府(Jeng-Fu You) ； 蔣昇甫(Sum-Fu Chaing) ； 賴正洲(Cheng-Chou Lai) ； 葉建裕(Chien-Yuh Yeh)

《中華民國大腸直腸外科醫學會雜誌》 28卷2期 (2017/06) Pp. 80-87

https://doi.org/10.6312/SCRSTW.2017.28(2).10521

摘要

Purpose. Currently there is no consensus about surveillance guideline for resected stage I colorectal cancer. In this study, we try to investigate risk factor of stage of metachronous colorectal cancer and the reasonable colonoscopy follow up interval. Materials and Methods. Between January 1995 and December 2015, total 17025 patients were diagnosed with colorectal cancer at the Linkou Chang Gung Memorial Hospital in Taiwan. Demographic data including sex, age, tumor location, index tumor location, original cancer’s pathological characteristics; preoperative carcinoembryonic antigen level, and colonoscopy follow up interval were all collected for analysis with Pearson’s chi-squared test and linear regression. Results. Total 2558 patients were diagnosed with stage I colorectal cancer and underwent standard curative operations.We recorded total 31 patients had metachronous colorectal cancer. Family cancer history, age, gender, underlying disease such as hypertension, coronary artery disease, diabete mellitus, previous CEA level before operation, resection method, TMN stage T1 or T2, and its original tumor site had no statistical significance compare with stage of metachronous colorectal cancer (p ＞ 0.05). Colonoscopy follow up interval do have association with metachronous cancer stage (p = 0.036). We get a regression curve equation. According to this equation, we may predict that if we want to control the second cancer within curable stage (within stage III), a reasonable follow up interval is 75 months. If we want to do more intensive surveillance in order to keep metachronous colorectal within stage II (No need of chemotherapy), a reasonable follow up interval is 52 months. Furthermore, if we follow colonoscopy every 8.4 months, the predict metachronous colorectal cancer stage would be within stage I. Conclusions. Colonoscopy follow up interval do have association with metachronous cancer stage. The recommend follow up interval is 75 months.

關鍵字

Stage I colorectal cancer ； Colonoscopy ； Follow up

並列摘要

目的 目前針對第一期大腸癌術後的病人，對於追蹤的準則並沒有統一的共識。在我們的研究中，我們嘗試著去尋找關於異時性大腸癌的嚴重程度的危險因子，以及合理的大腸鏡追蹤時間間格。方法 從1995 年1 月到2015 年12 月，在台灣林口長庚醫院總共有17025 個病人被診斷大腸癌，其中有2258 位病人是第一期並且接受治癒性手術。在之後的追蹤裡，我們總共發現了31 個病人有異時性大腸癌做進一步的分析。結果 在我們的資料庫裡，異時性大腸癌的嚴重度跟家族癌症史、年齡、性別、合併症如高血壓心臟病及糖尿病、第一次切除大腸癌時的CEA 數值、切除方式、T1 或T2、以及原始大腸癌的位置沒有統計學上顯著的相關。結論 大腸鏡追蹤的時間間格跟異時性大腸癌的嚴重程度有顯著相關，並且我們算出一條回歸曲線，根據這條曲線方程式，我們可以預測如果預期在發現異時性大腸癌時仍在可治癒的程度 (第三期以內)，合理的大腸鏡追蹤間格為75 個月。

並列關鍵字

第一期大腸癌 ； 大腸鏡 ； 追蹤

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