Risk Factor Analysis on Distant Metastasis and Local Recurrence after Curative Resection in Early-stage Middle and Low Rectal Cancer

早期中低位直腸癌術後局部復發及遠端轉移之危險因子分析

賴以立(I-Li Lai) ； 許祐仁(Yu-Jen Hsu) ； 陳繹中(Yih-Jong Chern) ； 游正府(Jeng-Fu You) ； 蔡文司(Wen-Sy Tsai) ； 謝寶秀(Pao-Shiu Hsieh) ； 洪欣園(Hsin-Yuan Hung) ； 江支銘(Jy-Ming Chiang)

《中華民國大腸直腸外科醫學會雜誌》 30卷3期 (2019/09) Pp. 117-126

https://doi.org/10.6312/SCRSTW.201909_30(3).10814

摘要

Purpose. The disease recurrence after curative surgery on early stage rectal cancer is frustrated and the patient number is scarce. This study aims to find out the risk factors in distant metastasis and local recurrence separately. Methods. Patients who were diagnosed with pT1 or pT2 rectal adenocarcinoma and treated by local excision or radical resection between January 2005 and December 2016 were retrospectively recruited in this study. The risk factors for recurrence were identified by p value ＜ 0.1 in Log-rank test from Kaplan-Meier survival analysis. Cox proportional hazard model was adopted individually to the risk factors for distant and local recurrences. Results. There were 350 patients enrolled in this study. The length of follow up time was 73.8 [46.1-107.6] (months). ＂Pre-operative CEA≥ 5 (ng/ mL)＂ [hazard ratio = 4.02 (1.42-11.36)] (p = 0.009) and ＂Early post-operative morbidity＂ [hazard ratio = 3.22 (1.17-8.83)] (p = 0.023) were risk factors for distant metastasis; ＂Resection margin ＜ 0.1 (cm)＂ [hazard ratio = 6.12 (1.48-25.46)] (p = 0.013) was risk factors for local recurrence. ＂Lympho-vascular invasion＂ [hazard ratio = 2.51 (0.87-7.26)] and ＂Tumor Diameter ≥ 3 (cm)＂ [hazard ratio = 5.08 (0.90-28.57)] had borderline significance (p ＜ 0.1). Conclusions. For early-stage rectal cancer, recurrence rate is low after curative surgery. We suggest carefully follow-up plan for those who has high-risk factors. Further study on follow-up strategy and adjuvant treatment are needed to achieve better survival.

關鍵字

Early-stage rectal cancer ； Distant metastasis ； Local recurrence ； Risk factor analysis

並列摘要

目的：對於接受根治性手術的早期直腸癌病人來說，疾病的復發並不常見，也對給予治療的醫師帶來挫折感。本研究討論遠端轉移及局部復發，企圖分別找出兩種不同復發方式的危險因子。方法：篩選於2005年至2016年間，林口長庚醫院接受局部切除或廣泛切除的根治性手術的病人，且其病理腫瘤分期為T1或T2。危險因子藉由Kaplan-Meier存活分析辨識，經Log-rank test檢定p值＜ 0.1者進入多因子迴歸分析，結果以風險比例（Hazard Ratio）呈現。結果：本研究共有350個病例，術後追蹤期中位數為73.8月。「術前癌胚抗原（CEA）大於等於5（ng／mL）」或「術後30天內有併發症」為遠端轉移的顯著危險因子；「腫瘤切除邊界小於等於0.1公分」為局部復發的顯著危險因子。其餘「淋巴血管侵犯」或「腫瘤直徑大於等於3公分」也有較高風險比例，但未達顯著統計差異。結論：對早期直腸癌來說，復發並不常見。就本研究發現的危險因子，或能提供有此類危險因子的病人，審慎的調整追蹤策略。對於輔助性治療的研究，也能提供有價值的啟發作用。

並列關鍵字

早期直腸癌 ； 遠端復發 ； 局部復發 ； 危險因子分析

參考文獻

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