PURPOSE:The purpose of this national study was to evaluate the results of treatment for young rectal cancer patients.METHODS:This prospective study from the Norwegian Rectal Cancer Project includes all 2,283 patients ...PURPOSE:The purpose of this national study was to evaluate the results of treatment for young rectal cancer patients.METHODS:This prospective study from the Norwegian Rectal Cancer Project includes all 2,283 patients younger than aged 70 years with adenocarcinoma of the rectum from November 1993 to December 1999.Patients younger than aged 40 years(n = 45) ,40 to 44 years(n = 87) ,45 to 49 years(n = 153) ,and 50 to 69 years(n = 1998) were compared for patient and tumor characteristics and five-year overall survival.Patients treated for cure(n = 1,354) were evaluated for local recurrence,distant metastasis,and disease-free survival.RESULTS:Patients younger than aged 40 years had significantly higher frequencies of poorly differentiated tumors(27 vs.12-16 percent;P = 0.014) ,N2-stage(37 vs.13-18 percent;P = 0.001) ,and distant metastases(38 vs.19-24 percent;P = 0.019) compared with older patients.Among those treated for cure,56 percent of the patients younger than aged 40 years developed distant metastases compared with 20 to 26 percent of the older patients(P = 0.003) .Overall five-year survival was 54 percent for patients younger than aged 40 years compared with 71 to 88 percent for the older patients(P = 0.029) .Age younger than 40 years was a significant independent prognostic factor and increased the risk for metastasis and death.CONCLUSIONS:Patients younger than aged 40 years had a more advanced stage at the time of diagnosis and poor prognosis compared with older patients.Young patients treated for cure more often developed distant metastases and had inferior survival.展开更多
BACKGROUND: Clinicopathologic staging of colorectal cancer remains the best predictor of survival. Prognostication for an individual with colorectal cancer remains elusive. This study was designed to investigate the i...BACKGROUND: Clinicopathologic staging of colorectal cancer remains the best predictor of survival. Prognostication for an individual with colorectal cancer remains elusive. This study was designed to investigate the incidence of free surface colorectal cancer cells detected by cytology during elective open curative resection, to correlate their presence with particular clinicopathologic variables and determine whether their presence was predictive of cancer-specific survival. METHODS: Over a six-year period in one institution, all elective colon and intraperitoneal rectal cancer specimens were assessed during primary resection for the presence of free colorectal cancer cells by means of a simple and tested specimen imprint cytology methodology. Clinicopathologic variables were assessed prospectively and blinded to cytology results. All patients were followed up routinely until death and if the patient was not seen within the last six months, information was obtained from the New South Wales Registry of Births, Deaths and Marriages in Australia. RESULTS: Overall, 26 of 281 (9.25 percent) colorectal cancers had positive cytology for cancer cells on the peritoneal surface of the bowel. Poorly differentiated tumors were significantly associated with positive cytology. Tumor penetration, presence of vascular or neural invasion, mucinous characteristics, lymph node status, and operative procedure performed were not statistically significant predictors of positive cytology. Overall, 43 of the 281 patients (15.3 percent) died during the mean followup period of 49.2 months from cancer-related deaths. Of these patients, 8 had positive cytology and 35 had negative cytology results. Cancer-specific survival assessed with the log-rank test was significantly associated with positive cytology in univariate (P = 0.008) and multivariate analysis (P < 0.001). CONCLUSION: In this study, the presence of free surface colorectal cancer cells has been shown to be predictive of survival and is independent of direct peritoneal invasion and lymph node status. Thus, further assessment of this simple prognostic variable is warranted and selection of patients with positive cytology for possible adjuvant therapies may be beneficial.展开更多
文摘PURPOSE:The purpose of this national study was to evaluate the results of treatment for young rectal cancer patients.METHODS:This prospective study from the Norwegian Rectal Cancer Project includes all 2,283 patients younger than aged 70 years with adenocarcinoma of the rectum from November 1993 to December 1999.Patients younger than aged 40 years(n = 45) ,40 to 44 years(n = 87) ,45 to 49 years(n = 153) ,and 50 to 69 years(n = 1998) were compared for patient and tumor characteristics and five-year overall survival.Patients treated for cure(n = 1,354) were evaluated for local recurrence,distant metastasis,and disease-free survival.RESULTS:Patients younger than aged 40 years had significantly higher frequencies of poorly differentiated tumors(27 vs.12-16 percent;P = 0.014) ,N2-stage(37 vs.13-18 percent;P = 0.001) ,and distant metastases(38 vs.19-24 percent;P = 0.019) compared with older patients.Among those treated for cure,56 percent of the patients younger than aged 40 years developed distant metastases compared with 20 to 26 percent of the older patients(P = 0.003) .Overall five-year survival was 54 percent for patients younger than aged 40 years compared with 71 to 88 percent for the older patients(P = 0.029) .Age younger than 40 years was a significant independent prognostic factor and increased the risk for metastasis and death.CONCLUSIONS:Patients younger than aged 40 years had a more advanced stage at the time of diagnosis and poor prognosis compared with older patients.Young patients treated for cure more often developed distant metastases and had inferior survival.
文摘BACKGROUND: Clinicopathologic staging of colorectal cancer remains the best predictor of survival. Prognostication for an individual with colorectal cancer remains elusive. This study was designed to investigate the incidence of free surface colorectal cancer cells detected by cytology during elective open curative resection, to correlate their presence with particular clinicopathologic variables and determine whether their presence was predictive of cancer-specific survival. METHODS: Over a six-year period in one institution, all elective colon and intraperitoneal rectal cancer specimens were assessed during primary resection for the presence of free colorectal cancer cells by means of a simple and tested specimen imprint cytology methodology. Clinicopathologic variables were assessed prospectively and blinded to cytology results. All patients were followed up routinely until death and if the patient was not seen within the last six months, information was obtained from the New South Wales Registry of Births, Deaths and Marriages in Australia. RESULTS: Overall, 26 of 281 (9.25 percent) colorectal cancers had positive cytology for cancer cells on the peritoneal surface of the bowel. Poorly differentiated tumors were significantly associated with positive cytology. Tumor penetration, presence of vascular or neural invasion, mucinous characteristics, lymph node status, and operative procedure performed were not statistically significant predictors of positive cytology. Overall, 43 of the 281 patients (15.3 percent) died during the mean followup period of 49.2 months from cancer-related deaths. Of these patients, 8 had positive cytology and 35 had negative cytology results. Cancer-specific survival assessed with the log-rank test was significantly associated with positive cytology in univariate (P = 0.008) and multivariate analysis (P < 0.001). CONCLUSION: In this study, the presence of free surface colorectal cancer cells has been shown to be predictive of survival and is independent of direct peritoneal invasion and lymph node status. Thus, further assessment of this simple prognostic variable is warranted and selection of patients with positive cytology for possible adjuvant therapies may be beneficial.
