切换至 "中华医学电子期刊资源库"

中华普通外科学文献(电子版) ›› 2019, Vol. 13 ›› Issue (04) : 263 -268. doi: 10.3877/cma.j.issn.1674-0793.2019.04.002

所属专题: 文献

论著

癌结节对结直肠癌肝转移同期切除术预后的影响
林奇1, 许剑民,1   
  1. 1. 200032 上海,复旦大学附属中山医院普通外科
  • 收稿日期:2019-06-10 出版日期:2019-08-01
  • 通信作者: 许剑民
  • 基金资助:
    国家自然科学基金面上项目(81472228)

Tumor deposit as a poor prognostic indicator in patients undergoing simultaneous resection forinitially resectable colorectal liver metastases

Qi Lin1, Jianmin Xu,1   

  1. 1. Department of General Surgery, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, China
  • Received:2019-06-10 Published:2019-08-01
  • Corresponding author: Jianmin Xu
  • About author:
    Corresponding author: Xu Jianmin, Email:
引用本文:

林奇, 许剑民. 癌结节对结直肠癌肝转移同期切除术预后的影响[J/OL]. 中华普通外科学文献(电子版), 2019, 13(04): 263-268.

Qi Lin, Jianmin Xu. Tumor deposit as a poor prognostic indicator in patients undergoing simultaneous resection forinitially resectable colorectal liver metastases[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2019, 13(04): 263-268.

目的

探讨癌结节对初始可切除同时性结直肠癌肝转移患者同期切除术预后的影响。

方法

回顾性分析2003年7月至2015年7月复旦大学附属中山医院行同期切除的212例同时性结直肠癌肝转移患者资料,分析癌结节和临床病理因素的相关性,采用Kaplan-Meier生存分析和Cox回归模型分析癌结节对预后的影响。

结果

癌结节的阳性率为43.9%(93/212),癌结节和肿瘤分化、淋巴结转移、血管浸润和神经浸润显著相关(P=0.044、0.001、0.035、<0.001),是低DFS的独立预后因素。癌结节阳性患者的OS和DFS明显低于癌结节阴性患者,差异有统计学意义(P=0.003、<0.001)。淋巴结阳性的135例患者中,癌结节阳性和阴性患者的OS比较,差异无统计学意义(P=0.608),癌结节阳性患者DFS更低(P=0.003);在淋巴结阴性的77例患者中,癌结节阳性患者的OS和DFS均显著低于癌结节阴性患者(P<0.001、0.010)。

结论

对于结直肠癌肝转移同期切除术后患者,癌结节和肿瘤分化、淋巴结转移以及神经浸润显著相关,且预示不良预后。

Objective

To determine the prognostic value of tumor deposits in initially resectable patients who underwent simultaneous resection for synchronous colorectal liver metastases (SCRLMs).

Methods

Between July 2003 and July 2015, clinicopathological and outcome data of two hundred and twelve consecutive SCRLMs patients who underwent simultaneous R0 resection were collected from SCRLMs database which was established prospectively. The prognostic value of tumor deposits was evaluated by Kaplan-Meier and Cox regression analysis.

Results

The positive rate of tumor deposits was 43.9% (93/212). Tumor deposits were significantly correlated with tumor differentiation, lymph node metastasis, vascular invasion and nerve invasion of the primary tumors (P=0.044, 0.001, 0.035, <0.001, respectively). Kaplan-Meier survival analysis revealed that the overall survival (OS) and disease-free survival (DFS) of SCRLMs patients with positive tumor deposits were significantly poorer than those with negative tumor deposits (P=0.003, <0.001, respectively). And multivariate analysis showed that positive tumor deposits were significantly associated with shorter DFS independent of lymph node status (P<0.001). Subgroup analysis found that in the 135 patients with positive lymph node status, the OS of patients with tumor deposits was not significantly different from those without tumor deposits (P=0.608); however, tumor deposits were significantly correlated with shorter DFS (P=0.003). In the 77 SCRLMs patients with negative lymph node status, tumor deposits were significantly associated with shorter OS and DFS (P<0.001, 0.010, respectively).

Conclusion

Tumor deposits may be an independent adverse prognostic factor for SCRLMs patients who underwent simultaneous R0 resection, which is significantly correlated with tumor differentiation, lymph node metastasis, vascular invasion and nerve infiltration.

表1 212例结直肠肝转移同期切除术后癌结节和临床病理因素的相关性[例(%)]
表2 212例结直肠癌肝转移患者同期切除术后临床病理因素和OS相关性分析
表3 212例结直肠癌肝转移患者同期切除术后临床病理因素和DFS相关性分析
图1 结直肠癌肝转移同期切除术后患者癌结节和总体生存率、无病生存率的Kaplan-Meier生存曲线分析 癌结节阳性的患者术后总体生存率(A)、无病生存率(B)均明显低于癌结节阴性的患者
图2 淋巴结转移的结直肠癌肝转移同期切除术后癌结节和总体生存率、无病生存率的Kaplan-Meier生存曲线分析 癌结节阳性和阴性的患者总体生存率比较,差异无统计学意义(A);癌结节阳性的患者无病生存率明显低于癌结节阴性患者(B)
图3 淋巴结转移的阴性结直肠癌肝转移同期切除术后癌结节和总体生存率、无病生存率的Kaplan-Meier生存曲线分析 癌结节阳性患者术后总体生存率(A)以及无病生存率(B)均明显低于癌结节阴性患者
[1]
Amin MB, Greene FL, Edge SB, et al. The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging[J]. CA Cancer J Clin, 2017, 67(2): 93-99.
[2]
Tong LL, Gao P, Wang ZN, et al. Is the seventh edition of the UICC/AJCC TNM staging system reasonable for patients with tumor deposits in colorectal cancer?[J]. Ann Surg, 2012, 255(2): 208-213.
[3]
Nagayoshi K, Ueki T, Nishioka Y, et al. Tumor deposit is a poor prognostic indicator for patients who have stage II and III colorectal cancer with fewer than 4 lymph node metastases but not for those with 4 or more[J]. Dis Colon Rectum, 2014, 57(4): 467-474.
[4]
Ueno H, Hashiguchi Y, Shimazaki H, et al. Peritumoral deposits as an adverse prognostic indicator of colorectal cancer[J]. Am J Surg, 2014, 207(1): 70-77.
[5]
Gopal P, Lu P, Ayers GD, et al. Tumor deposits in rectal adenocarcinoma after neoadjuvant chemoradiation are associated with poor prognosis[J]. Mod Pathol, 2014, 27(9): 1281-1287.
[6]
Ueno H, Mochizuki H, Shirouzu K, et al. Multicenter study for optimal categorization of extramural tumor deposits for colorectal cancer staging[J]. Ann Surg, 2012, 255(4): 739-746.
[7]
Belt EJ, van Stijn MF, Bril H, et al. Lymph node negative colorectal cancers with isolated tumor deposits should be classified and treated as stage III[J]. Ann Surg Oncol, 2010, 17(12): 3203-3211.
[8]
Ueno H, Mochizuki H, Shirouzu K, et al. Actual status of distribution and prognostic impact of extramural discontinuous cancer spread in colorectal cancer[J]. J Clin Oncol, 2011, 29(18): 2550-2556.
[9]
Lin Q, Wei Y, Ren L, et al. Tumor deposit is a poor prognostic indicator in patients who underwent simultaneous resection for synchronous colorectal liver metastases[J]. Onco Targets Ther, 2015, 8: 233-240.
[10]
Xu J, Qin X, Wang J, et al. Chinese guidelines for the diagnosis and comprehensive treatment of hepatic metastasis of colorectal cancer[J]. J Cancer Res Clin Oncol, 2011, 137(9): 1379-1396.
[11]
Sobin LH, Fleming ID. TNM classification of malignant tumors, fifth edition (1997). Union Internationale Contre le Cancer and the American Joint Committee on Cancer[J]. Cancer, 1997, 80(9): 1803-1804.
[12]
Wittekind C, Compton CC, Greene FL, et al. TNM residual tumor classification revisited[J]. Cancer, 2002, 94(9): 2511-2516.
[13]
Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM[J]. Ann Surg Oncol, 2010, 17(6): 1471-1474.
[14]
Nagtegaal ID, Quirke P. Colorectal tumour deposits in the mesorectum and pericolon: a critical review[J]. Histopathology, 2007, 51(2): 141-149.
[15]
Nagtegaal ID, Tot T, Jayne DG, et al. Lymph nodes, tumor deposits, and TNM: are we getting better?[J]. J Clin Oncol, 2011, 29(18): 2487-2492.
[16]
Ratto C, Ricci R, Rossi C, et al. Mesorectal microfoci adversely affect the prognosis of patients with rectal cancer[J]. Dis Colon Rectum, 2002, 45(6): 733-742.
[17]
Ishikawa K, Hashiguchi Y, Mochizuki H, et al. Extranodal cancer deposit at the primary tumor site and the number of pulmonary lesions are useful prognostic factors after surgery for colorectal lung metastases[J]. Dis Colon Rectum, 2003, 46(5): 629-636.
[18]
von Winterfeld M, Hoffmeister M, Ingold-Heppner B, et al. Frequency of therapy-relevant staging shifts in colorectal cancer through the introduction of pN1c in the 7th TNM edition[J]. Eur J Cancer, 2014, 50(17): 2958-2965.
[1] 张晓宇, 殷雨来, 张银旭. 阿帕替尼联合新辅助化疗对三阴性乳腺癌的疗效及预后分析[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 346-352.
[2] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[3] 高杰红, 黎平平, 齐婧, 代引海. ETFA和CD34在乳腺癌中的表达及与临床病理参数和预后的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 64-67.
[4] 徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[5] 李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[6] 梁孟杰, 朱欢欢, 王行舟, 江航, 艾世超, 孙锋, 宋鹏, 王萌, 刘颂, 夏雪峰, 杜峻峰, 傅双, 陆晓峰, 沈晓菲, 管文贤. 联合免疫治疗的胃癌转化治疗患者预后及术后并发症分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 619-623.
[7] 张志兆, 王睿, 郜苹苹, 王成方, 王成, 齐晓伟. DNMT3B与乳腺癌预后的关系及其生物学机制[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 624-629.
[8] 屈翔宇, 张懿刚, 李浩令, 邱天, 谈燚. USP24及其共表达肿瘤代谢基因在肝细胞癌中的诊断和预后预测作用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 659-662.
[9] 顾雯, 凌守鑫, 唐海利, 甘雪梅. 两种不同手术入路在甲状腺乳头状癌患者开放性根治性术中的应用比较[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 687-690.
[10] 付成旺, 杨大刚, 王榕, 李福堂. 营养与炎症指标在可切除胰腺癌中的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 704-708.
[11] 关小玲, 周文营, 陈洪平. PTAAR在乙肝相关慢加急性肝衰竭患者短期预后中的预测价值[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 841-845.
[12] 张润锦, 阳盼, 林燕斯, 刘尊龙, 刘建平, 金小岩. EB病毒相关胆管癌伴多发转移一例及国内文献复习[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 865-869.
[13] 陈晓鹏, 王佳妮, 练庆海, 杨九妹. 肝细胞癌VOPP1表达及其与预后的关系[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 876-882.
[14] 王景明, 王磊, 许小多, 邢文强, 张兆岩, 黄伟敏. 腰椎椎旁肌的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 846-852.
[15] 郭曌蓉, 王歆光, 刘毅强, 何英剑, 王立泽, 杨飏, 汪星, 曹威, 谷重山, 范铁, 李金锋, 范照青. 不同亚型乳腺叶状肿瘤的临床病理特征及预后危险因素分析[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 524-532.
阅读次数
全文
0
HTML PDF
最新录用 在线预览 正式出版 最新录用 在线预览 正式出版
0 0 0 0 0 0


摘要
58
最新录用 在线预览 正式出版
0 0 57
  来源 本网站 其他网站
  次数 11 47
  比例 19% 81%