<strong>Purpose:</strong> <span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">To identify clinical predictors for redu...<strong>Purpose:</strong> <span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">To identify clinical predictors for reduced long-term survival and </span><span><span style="font-family:Verdana;">describe the cause of death after surgical treatment for rectal cancer. </span><b><span style="font-family:Verdana;">Me</span></b></span><b><span style="font-family:Verdana;">thods:</span></b> <span style="font-family:Verdana;">A retrospective follow-up study of 442 consecutive, unselected patients</span><span style="font-family:Verdana;"> treated for rectal cancer at a tertiary centre from 1990 until 2000 and followed for 17 </span><span style="font-family:Verdana;">years or until death. Predictors for death were assessed by Cox regression</span><span style="font-family:Verdana;"> analysis. The cause of death was obtained from the Norwegian Cause of Death Registry. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">254 men and 188 women with a median age of 71 years (21 - 95 years) were resected for rectal cancer with low anterior resection (n = 266), abdominoperineal resection (n = 125), Hartmann’s procedure (n = 19) or diverting stoma only (n = 32). Median follow-up was 5 years (0 - 17 years). The relative five-year survival rates for stages I, II, III and IV was 83.9%, 65.2%, 41.1% and 9.3%, respectively. The proportion of deaths due to recurrence from colorectal cancer in stages I, II, III and IV was 23.5%, 55.8%, 72.3% and 98.0%, respectively. Heart, lung and cerebrovascular disease and other malignancies were the cause of death in the other patients. Higher age, </span><span style="font-family:Verdana;">abdominoperineal resection compared to low anterior resection, lack of</span><span style="font-family:Verdana;"> lymph node dissection compared to total mesorectal excision (TME), postoperative reoperations, TNM stages II and III compared to stage I and residual tumours after surgery were all significant independent predictors of reduced survival in the adjusted Cox regression model. </span><b><span style="font-family:Verdana;">Conclusions: </span></b><span style="font-family:Verdana;">Age, tu</span><span style="font-family:Verdana;">mour stage, type of surgery, lymph node dissection, residual tumour after</span><span style="font-family:Verdana;"> surgery and reoperations are predictors for survival after surgery for rectal cancer. In the patients who died, the cause of death was due to a condition other than colorectal cancer recurrence in 32.3% of the patients. The five-year relative survival rate was related to tumour stage.</span></span></span></span>展开更多
<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Clinical predictors of death and survival in surgical treatme...<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Clinical predictors of death and survival in surgical treatment </span><span style="font-family:Verdana;">of colon cancer are easily confounded by the modern adjuvant and</span><span style="font-family:Verdana;"> neo-adjuvant chemotherapy. This study focuses on lethality and survival during implementation of ultra-radical surgery for colonic cancer prior to multimodal therapy. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">Retrospective observational follow-up study of 824 consecutive, unselected patients resected for Stage I, II, III and IV colon cancer from 1990 until 2000 at one tertiary centre, with a median follow-up of 45 months (0 - 202 months). Predictors for death were assessed by Cox regression analyses and log-rank test. The cause of death was obtained from the Norwegian Cause of Death Registry. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The relative survival rates were 86.3%, 71.9%, 50.3% and 6.6% in Stage I, II, III and IV, respectively. In 28.7% </span><span style="font-family:Verdana;">of the patients, the cause of death was other than colorectal cancer recur</span><span style="font-family:Verdana;">rence. </span><span style="font-family:Verdana;">The adjusted Cox regression model showed that higher age (1.04 (95% CI:</span><span style="font-family:Verdana;"> 1.03;1.05)), male gender (1.37 (1.14;1.66)), emergency surgery (1.52 (1.21;</span><span style="font-family:Verdana;">1.93)), left vs. right hemicolectomy (1.39 (1.03;1.87)), and perioperative</span><span style="font-family:Verdana;"> blood transfusion (1.25 (1.01;1.55)) were predictors of reduced survival. Health without known comorbidity (0.71 (0.58;0.88)), D2 versus D1 lymph node dissection (0.66 (0.53;0.83)) and tumour Stage I, II, III versus Stage IV 0.10 (0.06;0.16), 0.14 (0.11;0.19), 0.23 (0.18;0.30) were associated with prolonged survival. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> In 28.7% of the patients, the cause of death was other than colorectal cancer recurrence. Age, sex, comorbidity, emergency resec</span><span style="font-family:Verdana;">tion, lack of lymph node dissection, tumour stage, and preoperative blood</span><span style="font-family:Verdana;"> transfusions are all significant predictors for reduced survival after surgery for colon cancer.</span></span>展开更多
Purpose: To identify clinical predictors of recurrence of colorectal cancer after curative surgical treatment. Methods: Retrospective follow-up-study of 925 consecutive patients treated with R0-resection for colorecta...Purpose: To identify clinical predictors of recurrence of colorectal cancer after curative surgical treatment. Methods: Retrospective follow-up-study of 925 consecutive patients treated with R0-resection for colorectal cancer Stage I, II and III from 1990 until 2000 with a mean follow-up of 60 ± 37 months. Predictors for cancer recurrence were identified in a pilot-sample of these patients, followed by analyses of the rest of the patients (test-sample), and finally with a concluding analyses of the entire patient group. Data were analyzed with Pearson Chi-square test (χ2), Cox regression analyses and log rank test. Results: Tumor stage (Stage I: HR 0.10 (0.05;0.19), Stage II: HR 0.31 (0.24;0.41)) and postoperative reoperations due to complications due to other causes than anastomotic leakage (HR 2.02 (1.21;3.36)) were significant predictors of cancer recurrence in the multivariate Cox regression model. The association between reoperations and recurrence was strongest for the patients with the best prognosis: Stage I and Stage II-cancers. Long duration of surgery, strongly associated with blood-loss and infusions of liquid and blood-products, reoperation due to anastomotic leakage as well as right colon/transversum localization were significant at a trend-level (10%). Conclusions: Tumor stage and reoperations due to postoperative complications other than anastomotic leakage are significant predictors for recurrence after curative surgery for colorectal cancer.展开更多
文摘<strong>Purpose:</strong> <span><span><span style="font-family:;" "=""><span style="font-family:Verdana;">To identify clinical predictors for reduced long-term survival and </span><span><span style="font-family:Verdana;">describe the cause of death after surgical treatment for rectal cancer. </span><b><span style="font-family:Verdana;">Me</span></b></span><b><span style="font-family:Verdana;">thods:</span></b> <span style="font-family:Verdana;">A retrospective follow-up study of 442 consecutive, unselected patients</span><span style="font-family:Verdana;"> treated for rectal cancer at a tertiary centre from 1990 until 2000 and followed for 17 </span><span style="font-family:Verdana;">years or until death. Predictors for death were assessed by Cox regression</span><span style="font-family:Verdana;"> analysis. The cause of death was obtained from the Norwegian Cause of Death Registry. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">254 men and 188 women with a median age of 71 years (21 - 95 years) were resected for rectal cancer with low anterior resection (n = 266), abdominoperineal resection (n = 125), Hartmann’s procedure (n = 19) or diverting stoma only (n = 32). Median follow-up was 5 years (0 - 17 years). The relative five-year survival rates for stages I, II, III and IV was 83.9%, 65.2%, 41.1% and 9.3%, respectively. The proportion of deaths due to recurrence from colorectal cancer in stages I, II, III and IV was 23.5%, 55.8%, 72.3% and 98.0%, respectively. Heart, lung and cerebrovascular disease and other malignancies were the cause of death in the other patients. Higher age, </span><span style="font-family:Verdana;">abdominoperineal resection compared to low anterior resection, lack of</span><span style="font-family:Verdana;"> lymph node dissection compared to total mesorectal excision (TME), postoperative reoperations, TNM stages II and III compared to stage I and residual tumours after surgery were all significant independent predictors of reduced survival in the adjusted Cox regression model. </span><b><span style="font-family:Verdana;">Conclusions: </span></b><span style="font-family:Verdana;">Age, tu</span><span style="font-family:Verdana;">mour stage, type of surgery, lymph node dissection, residual tumour after</span><span style="font-family:Verdana;"> surgery and reoperations are predictors for survival after surgery for rectal cancer. In the patients who died, the cause of death was due to a condition other than colorectal cancer recurrence in 32.3% of the patients. The five-year relative survival rate was related to tumour stage.</span></span></span></span>
文摘<strong>Background:</strong> <span style="font-family:;" "=""><span style="font-family:Verdana;">Clinical predictors of death and survival in surgical treatment </span><span style="font-family:Verdana;">of colon cancer are easily confounded by the modern adjuvant and</span><span style="font-family:Verdana;"> neo-adjuvant chemotherapy. This study focuses on lethality and survival during implementation of ultra-radical surgery for colonic cancer prior to multimodal therapy. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">Retrospective observational follow-up study of 824 consecutive, unselected patients resected for Stage I, II, III and IV colon cancer from 1990 until 2000 at one tertiary centre, with a median follow-up of 45 months (0 - 202 months). Predictors for death were assessed by Cox regression analyses and log-rank test. The cause of death was obtained from the Norwegian Cause of Death Registry. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The relative survival rates were 86.3%, 71.9%, 50.3% and 6.6% in Stage I, II, III and IV, respectively. In 28.7% </span><span style="font-family:Verdana;">of the patients, the cause of death was other than colorectal cancer recur</span><span style="font-family:Verdana;">rence. </span><span style="font-family:Verdana;">The adjusted Cox regression model showed that higher age (1.04 (95% CI:</span><span style="font-family:Verdana;"> 1.03;1.05)), male gender (1.37 (1.14;1.66)), emergency surgery (1.52 (1.21;</span><span style="font-family:Verdana;">1.93)), left vs. right hemicolectomy (1.39 (1.03;1.87)), and perioperative</span><span style="font-family:Verdana;"> blood transfusion (1.25 (1.01;1.55)) were predictors of reduced survival. Health without known comorbidity (0.71 (0.58;0.88)), D2 versus D1 lymph node dissection (0.66 (0.53;0.83)) and tumour Stage I, II, III versus Stage IV 0.10 (0.06;0.16), 0.14 (0.11;0.19), 0.23 (0.18;0.30) were associated with prolonged survival. </span><b><span style="font-family:Verdana;">Conclusions:</span></b><span style="font-family:Verdana;"> In 28.7% of the patients, the cause of death was other than colorectal cancer recurrence. Age, sex, comorbidity, emergency resec</span><span style="font-family:Verdana;">tion, lack of lymph node dissection, tumour stage, and preoperative blood</span><span style="font-family:Verdana;"> transfusions are all significant predictors for reduced survival after surgery for colon cancer.</span></span>
文摘Purpose: To identify clinical predictors of recurrence of colorectal cancer after curative surgical treatment. Methods: Retrospective follow-up-study of 925 consecutive patients treated with R0-resection for colorectal cancer Stage I, II and III from 1990 until 2000 with a mean follow-up of 60 ± 37 months. Predictors for cancer recurrence were identified in a pilot-sample of these patients, followed by analyses of the rest of the patients (test-sample), and finally with a concluding analyses of the entire patient group. Data were analyzed with Pearson Chi-square test (χ2), Cox regression analyses and log rank test. Results: Tumor stage (Stage I: HR 0.10 (0.05;0.19), Stage II: HR 0.31 (0.24;0.41)) and postoperative reoperations due to complications due to other causes than anastomotic leakage (HR 2.02 (1.21;3.36)) were significant predictors of cancer recurrence in the multivariate Cox regression model. The association between reoperations and recurrence was strongest for the patients with the best prognosis: Stage I and Stage II-cancers. Long duration of surgery, strongly associated with blood-loss and infusions of liquid and blood-products, reoperation due to anastomotic leakage as well as right colon/transversum localization were significant at a trend-level (10%). Conclusions: Tumor stage and reoperations due to postoperative complications other than anastomotic leakage are significant predictors for recurrence after curative surgery for colorectal cancer.