陈鹏, 左忠林, 冯立波, 陈小龙, 胡欣雨, 刘庆, 夏冬. 癌结节与结直肠癌患者临床病理因素及预后关系的研究[J]. 中国肿瘤临床, 2019, 46(15): 773-779. DOI: 10.3969/j.issn.1000-8179.2019.15.449
引用本文: 陈鹏, 左忠林, 冯立波, 陈小龙, 胡欣雨, 刘庆, 夏冬. 癌结节与结直肠癌患者临床病理因素及预后关系的研究[J]. 中国肿瘤临床, 2019, 46(15): 773-779. DOI: 10.3969/j.issn.1000-8179.2019.15.449
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Chen Peng, Zuo Zhonglin, Feng Libo, Chen Xiaolong, Hu Xinyu, Liu Qing, Xia Dong. Correlation between clinicopathologic features and prognosis in colorectal cancer patients with tumor deposits[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2019, 46(15): 773-779. DOI: 10.3969/j.issn.1000-8179.2019.15.449
Citation: Chen Peng, Zuo Zhonglin, Feng Libo, Chen Xiaolong, Hu Xinyu, Liu Qing, Xia Dong. Correlation between clinicopathologic features and prognosis in colorectal cancer patients with tumor deposits[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2019, 46(15): 773-779. DOI: 10.3969/j.issn.1000-8179.2019.15.449
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癌结节与结直肠癌患者临床病理因素及预后关系的研究

Correlation between clinicopathologic features and prognosis in colorectal cancer patients with tumor deposits

    摘要
  • 摘要:
      目的  分析结直肠癌中与癌结节（tumor deposits，TD）状态及数目相关的临床病理因素，探讨与验证第8版TNM分期中TD分期方法的合理性。
      方法  回顾性分析2013年8月至2017年12月于西南医科大学附属医院行根治术的结直肠癌患者病例资料，对患者生存情况进行随访，分析不同TD状态及数目下各临床病理因素的分布差异及预后区别，并从预后的角度验证第8版TNM分期中TD分期方法的合理性。
      结果  T分期是TD发生的独立危险因素，肿瘤分化程度是TD数目的独立危险因素。TD阴性组预后优于TD阳性组，差异具有统计学意义（P < 0.001）。生存曲线随着TD数目的增加而逐渐降低（P < 0.05），但TD=2组与TD=3组间生存曲线差异无统计学意义（P=0.186）。依据cutoff值将TD分为TD=1、TD=2~3与TD ≥ 4具有明显预后差异的三组。同属于ⅢB期的T3~4aN1c期与T3~4aN1a/1b期预后不同（P=0.022）。相同数量TD与区域淋巴结转移预后不完全相同。
      结论  结直肠癌合并TD提示预后不良。不同TD数目对预后的影响不同，TD=1、TD=2~3及TD ≥ 4是三个可能的分层标准。第8版TNM分期中的TD分期方法可能不甚合理。

     

    Abstract:
      Objective  To assess clinicopathologic features of patients with tumor deposits (TDs) in colorectal cancer (CRC) and evaluate the rationality of TD staging in the 8th edition of the TNM classification (TNM 8th edition).
      Methods  Overall, 517 patients with CRC who were surgically treated from August 2013 to December 2017 were retrospectively examined. Univariate and multivariate analyses were performed to identify correlations between clinicopathological features and TD, and survival analysis was performed to compare patients' clinicopathological status and different number of TDs. The effectiveness of the TD staging system using the TNM 8th edition was validated by prognostic analysis.
      Results  The tumor stage and degree of differentiation were independent risk factors for the status and number of TDs, respectively. Survival analysis indicated that patients with TD exhibited a significantly poorer prognosis than those without TD (P < 0.001). The prognosis of patients with different numbers of TDs significantly worsened as the number of TDs increased (all P < 0.05); however, there was no significant difference between TD=2 and TD=3 (P=0.186). With respect to the cutoff value for the number of TDs, TD was divided into three groups (TD=1, TD=2-3, and TD ≥ 4), each representing a significant difference in prognosis. Patients in the T3-4aN1a/1b category experienced a worse prognosis than those in the T3-4aN1c group, although both were classified as TNM ⅢB (P=0.022). Furthermore, there was no consistent difference in the prognosis of groups with equal numbers of TDs and lymph node metastasis.
      Conclusions  TDs in CRC is a potential adverse indicator. A different number of TDs may lead to a different prognosis, with TD=1, TD=2-3, and TD ≥ 4 likely representing three separate risk groups. Furthermore, the TD staging system described in the TNM 8th edition may not be very accurate.

     

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