Comparisons of the Clinic-pathological Features, Risk of Metachronous Tumor and Survival among Colorectal Cancer Patients with Different Family History

比較不同家族史對於結直腸癌病人之臨床病理特徵，異時性結直腸癌的風險及術後存活之影響

江支銘(Jy Ming Chiang) ； 蔣昇甫(Sum Fu Chiang) ； 謝寶秀(Pao Shiu Hsieh) ； 葉建裕(Chien Yuh Yeh) ； 游正府(Jeng Fu You) ； 洪欣園(Hsin Yun Huang) ； 蔡文司 ； 陳進勛(Jinn Shiun Chen) ； 游耀東 ； 唐瑞平(Reiping Tang)

《中華民國大腸直腸外科醫學會雜誌》 29卷1期 (2018/03) Pp. 45-55

https://doi.org/10.6312/SCRSTW.2018.29(1).10624

摘要

Purpose. We investigate whether the family history (FH) of patients with colorectal cancer (CRC) affects their clinic-pathologic features, treatment outcomes, and post-operative follow-ups. Patients and Methods. A total of 14082 CRC cases with complete data were identified. Clinicopathological features, treatment outcomes, and risk of developing metachronous CRC were compared across case groups with different FHs, using the multivariate Cox proportional hazard model. Results. Among five patient groups with different FHs, patients with hereditary nonpolyposis colorectal cancer (HNPCC) displayed a lower frequency of rectal cancer than colon cancer (27.6%, p ＜ 0.0001), presence of multiple tumors (27.9%, p ＜ 0.0001), younger age, location predominance in the right side of the colon (49.5%), higher proportion of mucinous adenocarcinoma (15.0%), more poorly differentiated cancers, less lymph node metastases (61.1%, p ＜ 0.0001), and reduced rate of distant metastases (11.2%), compared with other groups. Patients with positive FH had better OS (hazard ratios 0.873, p ＜ 0.0001) and better RFS (hazard ratios 0.872, 95% CI 0.800-0.949, p = 0.0016) than those with sporadic CRC. The incidence of metachronous CRC occurrence among patients with sporadic, FAP, HNPCC, positive FH, and HNPCC-like diagnoses were 2.36, 1.44, 7.55, 2.94, and 5.71 per 1000 person-years, respectively (p = 0.0005). Risk ratios of metachronous CRC for HNPCC and HNPCC-like cancer were 4.185-fold (p ＜ 0.0001) and 2.49-fold (p = 0.003) higher than patients with sporadic colon cancer, respectively. Conclusions. There are different clinic-pathologic characteristics, risk of metachronous CRC, and treatment outcomes among patients with CRC with different FHs.

關鍵字

Colorectal cancer ； Familial history ； HNPCC ； FAP

並列摘要

目的：本研究探討家族史對於結直腸癌(CRC)患者是否影響臨床病理特徵，治療結果和術後追蹤。方法：包括14082例的CRC病人。利用多變量Cox比例風險模型，比較不同家族史的病人，對於臨床病理特徵，治療結果和異時性CRC的風險。結果：在五個不同家族史患者組中，遺傳性非息肉性結腸直腸癌(HNPCC)患者，除了年齡較小；較多位於右結腸(49.5%)；粘液型腺癌(15.0%)；及分化較差之外；直腸癌(vs.結腸)頻率較低(27.6%, p ＜ 0.0001)；多發性腫瘤較高(27.9%, p ＜ 0.0001)；較少淋巴結轉移(61.1%, p ＜ 0.0001)；而遠處轉移率較低(11.2%)。有家族史病人OS明顯高於偶發性CRC(風險比0.873；p ＜ 0.0001)，且RFS明顯優於偶發性CRC(HR: 0.872, p = 0.0016)。偶發性CRC，FAP，HNPCC，陽性FH及HNPCC-like五組病人中，異時性CRC發生率分別為2.36、1.44、7.55、2.94和5.71/1000人(p = 0.0005)。HNPCC及HNPCC-like病人之異時性CRC的風險分別顯著高出偶發性CRC4.185倍(p ＜ 0.0001)，及2.49倍(p = 0.003)。結論：不同家族史的CRC患者存在不同的臨床病理特徵，異時性CRC的風險和治療結果。

並列關鍵字

遺傳性非息肉性結腸直腸癌 ； 偶發性結直腸癌 ； 家族史 ； 異時性結直腸癌

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