Atsushi I, Mitsuyoshi O, Kazuya Y, Syuhei K, Noriyuki K, Masashi M, Akira W, Kentaro S, Nobuyuki K, Natsuko S, Jun W, Yasushi I, Chikara K, Itaru E. Long-term outcomes and prognostic factors of patients with obstructive colorectal cancer: A multicenter retrospective cohort study. World J Gastroenterol 2016; 22(22): 5237-5245 [PMID: 27298566 DOI: 10.3748/wjg.v22.i22.5237]
Corresponding Author of This Article
Atsushi Ishibe, MD, PhD, Department of Gastroenterological Surgery, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan. aishibe@yokohama-cu.ac.jp
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
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Table 2 Patterns of recurrence following colorectal resection of obstructive colorectal cancer (n = 71)
Site of recurrence
n (%)
Liver
27 (11.5)
Lung
22 (9.4)
Peritoneal dissemination
21 (9.0)
Local recurrence
9 (3.8)
Lymph node
6 (2.6)
Anastomosis
3 (1.3)
Abdominal wall
2 (0.9)
Pleural dissemination
2 (0.9)
Table 3 Result of the univariate and multivariate analysis of risk factors for recurrence
Factor
n
Univariate analysis
Multivariate analysis
3-yr RFS
5-yr RFS
P value
HR (95%CI)
P value
Gender
M
141
59.2%
47.6%
0.409
F
93
66.8%
54.7%
Age (yr)
≥ 75
96
55.0%
42.4%
0.011
1.228 (0.659-2.290)
0.518
< 75
138
67.3%
55.9%
ASA-PS
1
71
75.7%
64.8%
0.017
2.234 (1.101-4.535)
0.026
2-3
163
56.6%
44.6%
BMI (kg/m2)
≥ 25
28
66.0%
49.7%
0.951
< 25
193
62.7%
52.7%
Serum albumin (g/dL)
≤ 4.0
172
54.9%
41.3%
0.001
2.967 (1.342-6.560)
0.007
> 4.0
48
79.7%
73.1%
CEA (mg/dL)
≥ 5.0
102
52.4%
44.8%
0.052
< 5.0
113
74.1%
54.2%
Decompression
+
183
62.9%
50.7%
0.572
-
51
60.5%
50.4%
Location of tumor
Right side
69
62.5%
55.5%
0.738
Left side
165
62.1%
48.7%
Tumor size (mm)
≥ 50
99
61.0%
48.8%
0.384
< 50
121
63.9%
54.1%
Differentiation of tumor
tub1,tub2
222
63.7%
51.2%
0.080
por, muc
12
36.7%
36.7%
Depth of tumor
T3
108
73.5%
64.7%
0.001
2.728 (1.467-5.072)
0.002
T4
126
53.0%
38.7%
Intramural lymphatic invasion
+
157
61.4%
53.2%
0.600
-
73
64.4%
45.2%
Intramural vascular invasion
+
164
60.3%
49.3%
0.683
-
70
68.1%
57.4%
Lymph node involvement
+
120
65.7%
47.4%
0.856
-
114
59.1%
53.2%
Lymph node dissection
D0,D1
31
44.3%
44.3%
0.067
D2,D3
199
64.7%
50.8%
No. of lymph nodes harvested
< 12
73
54.8%
44.5%
0.085
≥ 12
151
66.4%
52.5%
Postoperative complication
+
78
57.3%
44.7%
0.071
(≥ Grade 2)
-
156
64.7%
53.5%
Anastomotic leakage
+
18
71.1%
56.9%
0.562
-
191
61.7%
50.0%
Curability
R0
219
66.4%
54.8%
< 0.001
6.555 (1.344-31.970)
0.020
R1
15
7.6%
0.0%
Adjuvant chemotherapy
+
91
66.2%
55.6%
0.069
-
143
59.8%
47.2%
Table 4 Result of the univariate and multivariate analysis of prognostic factors for cancer-specific survival
Factor
n
Univariate analysis
Multivariate analysis
3-yr CSS
5-yr CSS
P value
HR(95%CI)
P value
Gender
M
141
88.3%
80.8%
0.924
F
93
87.8%
79.7%
Age (yr)
≥ 75
96
82.2%
71.6%
0.027
1.464 (0.647-3.310)
0.360
< 75
138
91.9%
85.4%
ASA-PS
1
71
86.0%
83.5%
0.710
2-3
163
89.0%
78.7%
BMI (kg/m2)
≥ 25
28
92.0%
85.8%
0.389
< 25
193
87.3%
80.0%
Serum albumin (g/dL)
≤ 4.0
172
85.6%
82.6%
0.536
> 4.0
48
87.7%
76.2%
CEA (mg/dL)
≥ 5.0
102
86.7%
80.0%
0.715
< 5.0
113
90.5%
82.0%
Decompression
+
183
88.4%
81.7%
0.514
-
51
87.1%
74.8%
Location of tumor
Right side
69
82.6%
70.5%
0.103
Left side
165
90.4%
84.3%
Tumor size (mm)
≥ 50
99
84.1%
76.9%
0.291
< 50
121
90.4%
85%
Differentiation of tumor
tub1, tub2
222
89.9%
82.5%
0.001
6.282 (1.584-24.909)
0.009
por, muc
12
50.0%
50.0%
Depth of tumor
T3
108
95.7%
92.3%
0.001
3.458 (1.324-9.031)
0.011
T4
126
81.1%
69.2%
Intramural lymphatic invasion
+
157
90.8%
82.7%
0.449
-
73
86.9%
79.4%
Intramural vascular invasion
+
164
94.2%
90.1%
0.152
-
70
85.9%
76.7%
Lymph node involvement
+
120
92.5%
82.9%
0.332
-
114
84.0%
77.7%
Lymph node dissection
D0, D1
31
60.7%
60.7%
0.014
0.958 (0.300-3.056)
0.942
D2, D3
199
90.4%
83.0%
No. of lymph nodes harvested
< 12
73
83.3%
78.3%
0.314
≥ 12
151
91.1%
81.0%
Postoperative complication
+
78
85.9%
75.6%
0.644
(≥ Grade 2)
-
156
89%
82.5%
Anastomotic leakage
+
18
100%
100%
0.069
-
191
87.1%
78.7%
Curability
R0
219
91.3%
84.7%
< 0.001
6.162 (1.692-22.445)
0.006
R1
15
39.7%
19.9%
Adjuvant chemotherapy
+
91
87.7%
81.8%
0.800
-
143
88.8%
79.4%
Citation: Atsushi I, Mitsuyoshi O, Kazuya Y, Syuhei K, Noriyuki K, Masashi M, Akira W, Kentaro S, Nobuyuki K, Natsuko S, Jun W, Yasushi I, Chikara K, Itaru E. Long-term outcomes and prognostic factors of patients with obstructive colorectal cancer: A multicenter retrospective cohort study. World J Gastroenterol 2016; 22(22): 5237-5245