Pathlogical Staging Discussion About Locally Advanced Colorectal Cancer Patients With Combined Organ Resection

Objectives:This study aimed to explore pathologic staging For locally advanced colorectal cancer(CCR) patients combined organ resection,and find a better reflect the staging of colorectal cancer survival prognosis, and provide a theoretical basis for the selection of patients to guide treatment options.Methods:This study reviewed 76 patients with locally advanced colorectal cancer patients received radical surgery or combined organ resection in the Third Affiliated Hospital of Kunming Medical University, since January 1,2000 to December 1,2010. There are 47 cases of stage ⅡB,29 cases of stage ⅡC, ⅡC patients underwent radical combined organ resection, and The patients were divided into inflammatory infiltration group 17 cases and cancerous infiltration group 12 cases according to Pathological examination.Analysising stage ⅡB,stage II C,inflammatory infiltration group and cancerous infiltration group patients of 5-year overall survival(5-OS) and the 5-year disease-free survival(5-DFS) by Kaplan-Meier survival analysis.These patients were re-staging,which are new stage ⅡB [stage II B+inflammatory infiltration group] and new stage ⅡC [cancerous infiltration group],and analysis new stage ⅡB, new stage ⅡC patients of 5-OS and 5-DFS by Kaplan-Meier survival analysis.Analysising of prognostic factors in patients by COX Risk Model.Results:The study included 76 colorectal cancer patients,stage ⅡB 47 cases, stage ⅡC 29 cases, stage ⅡC patients underwent radical combined organ resection.Mostly resected organ was uterus and ovarian for rectal cancer patients, and the small intestine for colon cancer patient.Analysising stage ⅡB and stage ⅡC patient’s general clinical data of patients by Chi-square test, the results showed general clinical data are no significant difference between two groups of patients(P> 0.05).Comparing combined organ radical resection with standard radical surgery did not significantly increase blood loss, perioperative blood transfusion, hospital stay and complications (P> 0.05).Kaplan-Meier survival curve showed stage ⅡB colorectal cancer patients with 5-OS and 5-DFS were similar to stage ⅡC patients (5-OS Group:Log Rank=2.349, P= 0.1253; 5-DFS:Log Rank=2.061, P=0.1511). By pathological examination, stage ⅡC patients included 12(41.4%) patients with cancerous infiltration involved organs and 17(58.6%) patients with inflammatory infiltration involved organs. Survival analysis showed that 5-OS and 5-DFS of inflammatory infiltration groups were significantly better than cancerous infiltration group (5-OS:Log Rank=4.149, P= 0.0416; 5-DFS:Log Rank=4.088, P=0.0432). Respectively compared The inflammatory infiltration group and cancerous infiltration group were with stage ⅡB patients, The results showed that inflammatory infiltration group and stage ⅡB patients with 5-OS and 5-DFS were no significant differences (5-OS:Log Rank= 0.000, P=0.9841; 5-DFS:Log Rank=0.013, P=0.9106), The 5-OS and 5-DFS of cancerous infiltration group was significantly worse than stage ⅡB patients (5-OS: Log Rank=7.919, P=0.0049; 5-DFS:Log Rank=7.624, P=0.0058). These patients were re-staging,which are new stage ⅡB [stage ⅡB+inflammatory infiltration group] and new stage ⅡC [cancerous infiltration group],and then survival analysis results suggest that the new stage ⅡC patients with 5-OS and 5-DFS was significantly worse than the new stage ⅡB patients (5-OS:Log Rank=8.249, P= 0.0041; 5-DFS:Log Rank=8.261, P=0.0041).By COX Risk Model analysising invasive nature of organ involved, tumor size, number of lymph node detection preoperative CEA value, histological differentiation, histological type, gender,age and tumor location,The results suggest that cancerous infiltration, number of lymph node detection<12, poorly differentiated and mucinous adenocarcinoma were the independent risk factors for locally advanced colorectal cancer patients with poor prognosis (P<0.05).Conclusions:1. Combined organ resection for colorectal cancer patients with surrounding organs invasived is safe and feasible.2. NCCN Guidelines can not fully reflect differences in survival prognosis of stage ⅡB and stage II C patients,there is something wrong, it may influence the choice of the patient treatment options.3. The 5-OS,5-DFS for locally advanced colorectal cancer patients with inflammatory infiltration involved organ were significantly better than patients with cancerous infiltration involved organs,and is similar to stage ⅡB colorectal cancer patients’survival.4. The independent risk factors for locally advanced colorectal cancer patients with poor prognosis include cancerous infiltration,the number of obtained lymph nodes samples<12,poorly differentiated and mubinous adenocarcinoma.5. According to the nature of involved organ infiltration,We seem to be necessary to divide T4b into inflammatory infiltration (T4bⅰ) and cancerous infiltration (T4bⅱ) two subtypes, and the T4b;N0M0 and T4aN0M0 patients should be classified as stage II B,T4bⅱN0M0 patients classified as stage ⅡC. Whether this staging method is more scientific and reasonable will still need multicenter large sample of cases verification and observe impact on the clinical treatment of choice.