Risk Factors of Different Tumor Recurrence Pattern in Stage II Colorectal Cancer

第二期大腸直腸癌不同復發位置的風險因子

Yen-Hang Wu(吳儼航) ； Hou-Hsuan Cheng(鄭厚軒) ； Sheng-Chieh Huang(黃聖捷) ； Hung-Hsin Lin(林宏鑫) ； Chun-Chi Lin(林春吉) ； Yuan-Tzu Lan(藍苑慈) ； Huann-Sheng Wang(王煥昇) ； Shung-Haur Yang(陳維熊) ； Wei-Shone Chen(姜正愷) ； Tzu-Chen Lin(楊純豪) ； Jeng-Kai Jiang(林資琛) ； Jen-Kou Lin(林楨國) ； Shih-Ching Chang(張世慶)

《中華民國大腸直腸外科醫學會雜誌》 33卷4期 (2022/12) Pp. 212-220

https://doi.org/10.6312/SCRSTW.202212_33(4).11124

摘要

Background. Colorectal cancer (CRC) recurrence was estimated around 10%-22.2% in stage II patients. Several clinicopathological features were found to be associated with recurrence. In this study, we attempted to find the risk factors of different tumor recurrence pattern in stage II CRC. Methods. A prospectively collected database contained 728 stage II CRC patients who underwent curative resection between January 2010 and December 2015. Using Cox's proportional hazards model, we examined the relationship between clinicopathological features and various recurrent patterns. Results. Tumor recurrence occurred in 77 (10.6%) stage II CRC patients. Conversely, local recurrence only occurred in 9 (1.24%) patients, distant metastasis only occurred in 60 (8.24%), and both local and distant recurrences in 8 (1.10%) patients. In terms of distant metastasis, 17 (2.33%) patients had only lung metastasis and 18 (2.47%) had only liver metastasis. Elevated postoperative CA19-9 (p = 0.018), and perineural invasion (p = 0.025) were independent risk factors for tumor recurrence. Elevated postoperative CA19-9 (p = 0.006) and perineural invasion (p = 0.004) were found to be independent risk factors for distant metastasis. Meanwhile, rectal cancer (p = 0.045) and elevated postoperative CEA(p = 0.009) were found to be independent risk factors for only lung metastasis. Elevated postoperative CA19-9 (p = 0.010) and obstruction (p < 0.001) were independent risk factors for only liver metastasis. Conclusions. Elevated postoperative tumor markers (both CA19-9 and CEA), tumor location, perineural invasion, and tumor obstruction are excellent predictors of prognosis in stage II CRC, and patients with these risks factors may benefit from intensive follow-up and adjuvant chemotherapy.

關鍵字

Colorectal cancer ； Stage II ； Risk factors of recurrence pattern

並列摘要

前言：第二期大腸直腸癌的病人約10%－22.2%復發。很多臨床病理因子被發現與復發有相關性。因此本篇要看看第二期大腸直腸癌不同復發模式的風險因子。方法：回顧性分析資料庫中2010年至2015年間被診斷出第二期大腸直腸癌的病人。使用Cox比例危險模型來分析臨床病理因子與不同復發模式的關係。結果：第二期大腸直腸癌的病人總共有77位復發，其中9位局部復發、60位遠端轉移。在遠端轉移的病人中，有17位只有肺部轉移、18位只有肝臟轉移。腫瘤復發的獨立風險因子包含了術後早期CA19-9上升與神經周邊侵犯。遠端轉移的獨立風險因子包含術後早期CA19-9上升與神經周邊侵犯。肺部轉移的獨立風險因子包含直腸癌與術後早期CEA上升。肝臟轉移的獨立風險因子包含術後早期CA19-9上升與腫瘤導致腸阻塞。結論術後早期腫瘤指標上升、腫瘤位置、神經周邊侵犯、腫瘤導致腸阻塞等是第二期大腸直腸癌的預後指標。有上述預後指標的病人，在密切追蹤和輔助性化療可能可以改善病人癒後。

並列關鍵字

第二期 ； 大腸直腸癌 ； 復發模式的風險因子