Title

Horizontal Tumor Size is Inversely Related to Prognosis in Nodal-Positive Stage III Colorectal Cancer

Translated Titles

第三期大腸直腸癌之橫向腫瘤大小為臨床預後之反向預測因子

DOI

10.6312/SCRSTW.2014.25(3).10306

Authors

吳志謙(Chih-Chien Wu);王瑞和(Jui-Ho Wang);金台明(Tai-Ming King);張敏琪(Min-Chi Chang);許詔文(Chao-Wen Hsu)

Key Words

大腸直腸癌 ; 橫向腫瘤大小 ; 預後 ; Colorectal cancer ; Horizontal tumor size ; Prognosis

PublicationName

中華民國大腸直腸外科醫學會雜誌

Volume or Term/Year and Month of Publication

25卷3期(2014 / 09 / 01)

Page #

65 - 73

Content Language

英文

Chinese Abstract

目的 腫瘤之垂直向生長程度是影響大腸直腸癌預後的重要因子,但腫瘤之橫向大小對預後影響之研究仍然有限且存在爭議。我們在此探討第三期大腸直腸癌有淋巴腺轉移之橫向腫瘤大小與其臨床預後之關係。方法 從1996年至2009年間,第三期有淋巴腺轉移之大腸直腸癌術後且有完整病歷記錄的病患被回溯性分析。腫瘤大小分別以0.5和1公分為分界,利用相關統計方法分析其預後之差異。結果 共939位病患被收錄。其中原發腫瘤大小小於1公分者共有57位,大於1公分者共882位。腫瘤小於1公分組之TNM分期為T1~2之比例大於腫瘤大於1公分組(42.1% vs. 27%,p = 0.02)。腫瘤小於1公分組之原發腫瘤位置也較腫瘤大於1公分組多位在直腸(61.7% vs. 45%,p = 0.01)。腫瘤小於1公分組之無疾病存活期中位數也顯著地短於腫瘤大於1公分組(6.96個月vs. 17.64個月,p = 0.003)。利用Cox比例風險迴歸模式分析,相對于腫瘤大小大於1公分者,腫瘤大小小於0.5公分之風險比值為2.29,腫瘤大小介於0.5至1公分則為1.224。進一步加入腫瘤位置作多變數分析後也顯示類似的結果。結論 對於第三期有淋巴腺轉移之大腸直腸癌患者,其腫瘤之大小可反向預測其臨床預後。我們推測腫瘤大小較小時即發生淋巴腺轉移,可能因其腫瘤行為相對腫瘤大小較大者來的具侵略性。這個發現更需要許多層面之研究來支持。

English Abstract

Purpose. Vertical tumor growth, reflected by the T classification, is the most important prognostic variable in colorectal cancer. However, the data regarding the prognostic impact of horizontal tumor size are limited and contradictory. In the present study, we aimed to investigate the effect of maximal horizontal tumor size on patient outcome in patients with nodal-positive stage III colorectal cancer. Methods. We retrospectively reviewed the medical records from 1996 to 2009. We included individuals diagnosed with nodal-positive stage III colorectal cancer who underwent surgical resection, and for whom complete medical records were available. In our analysis, the cut-off values for tumor size were set at 1.0 cm and 0.5 cm. A Kaplan-Meier survival analysis and the Cox proportional hazard model were applied to the data for further analysis. Results. In total, 939 nodal-positive stage III colorectal cancer specimens were reviewed retrospectively. We classified the patients into two groups: those with a maximum horizontal tumor size of < 1.0 cm (57 patients; 6%) and those with a maximum horizontal tumor size of > 1.0 cm (887 patients; 94%).With regard to the TNM classification, the group of patients with tumors < 1.0 cm in size had a greater number of T1-2 stage tumors compared to the group with tumors > 1.0 cm in size (42.1% vs. 27%, p = 0.02).With regard to the primary tumor site, the group of patients with tumors < 1.0 cm in size had a greater number of rectal tumors compared to the group with tumors > 1.0 cm in size (61.7% vs. 45%, p = 0.01). The median disease-free-survival was shorter in patients with tumors < 1.0 cm in size than in patients with tumors > 1.0 cm in size (6.96 months vs. 17.64 months, p = 0.003). Survival was significantly different between these two groups of patients as well (p = 0.008). Using a Cox proportional hazard model, the hazard ratio was found to be 2.29 for patients with tumors < 0.5 cm in size and 1.224 for those whose tumor measured 0.5-1.0 cm in size. Further multivariate analysis also demonstrated that small tumor size is a significant risk factor for a negative prognosis (p = 0.01). Conclusion. In nodal-positive stage III colorectal cancer, tumor size is inversely related to prognosis. We postulated that smaller nodal-positive tumors would display significantly more aggressive tumor behavior as compared to larger tumors. However, these interesting findings require further investigation to corroborate the results.

Topic Category 醫藥衛生 > 外科
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