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標題: | 針對第二期大腸癌是否含有黏液蛋白組織之長期預後比較 Comparison of long term outcome between radically resected stage II colorectal cancer with or without mucin histology |
作者: | Yi-Hsuan Chou 周邑宣 |
指導教授: | 吳明賢(Shiang-Ming Wu),邱瀚模(Han-Mo Chiu) |
關鍵字: | 第二期大腸癌,黏液蛋白,癌症復發率,癌症存活率,化學治療, stage II CRC,mucin histology,disease free survival, overall survival,chemotherapy, |
出版年 : | 2018 |
學位: | 碩士 |
摘要: | 前言:
大腸癌的發生率及盛行率日益提高。隨著糞便篩檢普及,更多早期癌能提早被診斷,而其治療及追蹤方式更是臨床重要課題。目前建議針對術後診斷為第三期 (淋巴轉移)的大腸癌需做化學治療;而目前化療對第二期大腸癌幫助仍有爭議。專 家會議仍強烈建議高危險性第二期大腸癌(手術淋巴檢體數目小於 12 個;手術前腫 瘤已經破裂;組織為腫瘤分化不良型;侵犯深度為 T4;腫瘤有淋巴血管侵犯或神經侵 犯)病人接受化療。然而化學治療對含有黏液蛋白(mucin)組織的第二期大腸癌(無淋巴轉移)存活是否有幫助仍有爭議:大多數國外期刊論文並不認為黏液蛋白是第二期大腸癌預後的危險因子,但許多研究發現黏液蛋白其生物特性對化學治療有 抗藥性或對末期大腸癌有不良預後。而我們在臨床上觀察也發現帶有黏液蛋白組 織的第二期病人比起沒有黏液蛋白的病人有較差的存活率。 方法: 我們設計了一單中心回溯性研究,回顧台大醫院十年來(2005~2014)術後診斷為 第二期大腸癌1031位病人病理組織是否帶有黏液蛋白的存活(overall survival)及無疾病復發預後 (disease free survival)是否不同。我們將組織病理細分成高惡性度 (high-grade),黏液型(mucinous),腺癌帶有黏液(AIM: mucin<50%)及非黏液型 (low grade)。 結果: 我們的研究發現第二期黏液型大腸癌(mucinous)比非黏液型(low- grade)第二期大腸癌有較差disease free survival (P=0.04, HR:1.71, 95% CI:1.02-2.88); 但overall survival(P=0.15, HR:1.45, 95% CI: 0.87-2.43)並無顯著差別。經多變相分 析包含考慮年齡、性別、腫瘤深度(T3 or T4)、腫瘤位置(直腸或非直腸)、是否有淋巴血管侵犯或神經侵犯與病人是否接受化學治療等因素發現黏液型大腸癌仍在 disease free survival顯現較差的預後(HR:1.78, 95%CI:1.03-3.10)。 結論: 在此回溯性研究中,黏液型大腸癌比起非黏液型大腸癌在 disease free survival 有較差的預後。因此可做為高風險因子及術後追加化學治療的參考指標;而化學治療對於第二期大腸癌的預後影響,仍需前瞻性研究佐證。 Background and aim: The incidence of colorectal cancer(CRC) was rising worldwide. Because the implementation of FIT screening, more and more early-staged CRCs were diagnosed. Therefore, it became an important issue how to manage these early-staged CRC, including stage II CRC. Stage II CRC with high risk features was known beneficial from adjuvant chemotherapy. High risk features included inadequate lymph node retrieval(N<12), tumor perforation before surgery, poorly differentiated histology, T4 tumor, lymphovascular or perineural invasion. However, whether the adjuvant chemotherapy was needed for stage II CRC with mucinous histology remained unknown. Therefore, this study aimed to investigate the difference in disease-free survival (DFS)and overall survival(OS) between stage II CRC with and without mucinous histology. Methods: This was a retrospective study and the subjects were enrolled from the list of NTUH cancer registry during 2005 to 2014. A total of 1031 radically resected stage II patients were enrolled. Each case was divided into one of the four groups by histology, including low-grade, high-grade, mucinous and adenocarcinoma with intermediate mucin (AIM) respectively. The recurrence and mortality was checked by chart review. Theprimary endpoint of our study were disease free survival and overall survival. The survival outcomes between different groups were compared with Log-rank test and cox- regression analysis. Results: The median follow-up period was 50.7 months in the study. The DFS was significantly worse in mucinous in comparison with low-grade counterpart(HR=1.71, 95% CI:1.02-2.88). OS was not significantly different between two groups (HR:1.45, 95% CI: 0.87-2.43). Mucinous histology was an independent risk factor of recurrence (HR:1.78, 95%CI:1.03-3.10) after adjusted by multivariate analysis. Conclusion: Mucinous histology had worse disease-free survival compared with low- grade adenocarcinoma in this retrospective study. Whether chemotherapy is beneficial for this specific group of patient needs further prospective study. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/70442 |
DOI: | 10.6342/NTU201802520 |
全文授權: | 有償授權 |
顯示於系所單位: | 臨床醫學研究所 |
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