Analysis Of Recurrence Or Metastasis Of Colorectal Cancer In Ⅱ And Ⅲ Stage

Objective: Through the analysis of the relationship between disease-free survival time(DFS)in Ⅱ and Ⅲ colorectal carcinoma after surgery with clinical and pathological factors include: colorectal cancer family history,age,gender,tumor location,depth of invasion,the number of lymph nodes,clinical pathologic stage,preoperative CEA or preoperative CA199 expression level,pathology type,the nerve or vascular invasion.Discuss the relationship between recurrence or metastasis site with primary tumor site.The affect to DFS by starting time of postoperative adjuvant chemotherapy(4 cycles)and chemotherapy regimens.The correlation between radiotherapy and local recurrence.The aim was to provide prognostic factors and reasonable treatment for patients with stage Ⅱ and Ⅲ colorectal cancer.Methods: The electronic medical record system collected 237 patients in Hospital form January 2007 to December 2015.Confirmed by clinical,imaging or pathological to be recurrenced,who underwent radical resection and postoperative pathology diagnosised to be stage Ⅱ,Ⅲ colorectal cancer without neoadjuvant therapy.The operation time start up to appeared recurrence or metastasis,records of patients with different clinical characteristics,details of adjuvant therapy,recurrence or metastasis site,in order to analysis DFS finally,the correlation between postoperative adjuvant treatment and DFS,the relation between recurrence or metastasis site with primary tumor site.Results:1.Relation between clinical characteristics and DFS: 237 cases of patients with Ⅱ and Ⅲ colorectal cancer after radical resection,the average age was 60.74±11.55 years,143 cases more than 60 years old.155 male patients,82 female patients,the ratio was1.89:1.T2 stage in 20 cases,168 cases of T3 stage,49 cases of T4 stage.The number of lymph node <12 in 120 cases,more than 12 has 109 cases,8 cases of unknown.Surgical staging was Ⅱ in 76 cases and Ⅲ in 161 cases.Advanced carcinoma in 61 cases,low grade cancer in 171 cases.Right colon had 50 cases,left colon had 41 cases,77 cases of upper and middle rectum,lower rectum in 64 cases,two primary tumor in 2 cases.There were 100 cases without nerve vascular invasion,46 cases with nerve vascular invasion.Postoperative radiotherapy for rectal cancer had 37 cases.Postoperative adjuvant chemotherapy in 141 cases.DFS and pathological stage,pathological grade and nerve vascular invasion were related(P<0.05).2.The relationship between DFS and postoperative adjuvant chemotherapy2.1 4 cycles of postoperative adjuvant chemotherapy was set up as the boundary,less than 4 cycles was considered as unfinished.The unfinished group has 127 cases,the median DFS was 13 months,the finished grounp has 110 cases,median DFS was 15 months,the difference was statistically significant(P =0.043).2.2 Of all the enrolled patients,35 received adjuvant chemotherapy within 4 weeks after surgery,whereas 61 received after 4 weeks following surgery.The mean disease-free survival of patients receiving adjuvant therapy earlier was 21 months,whereas patients with later treatment was 13 months.Significant differences in DFS were observed between the 2 groups(P=0.002).2.3 The different adjuvant chemotherapy regimens(FOLFOX,XELOX,Single Medicine of Fluorouracil)had no significant affect to DFS(p = 0.522).3.The relationship between postoperative adjuvant radiotherapy and local recurrence: There were 143 cases of rectal cancer patients with postoperative adjuvant radiotherapy,including 47 cases of local recurrence,37 cases of postoperative radiotherapy,,There was no statistically significant difference(P=0.438).4.Relationship between recurrence or metastasis site and primary tumor location.4.1 Recurrence or metastasis site: 75 cases had local recurrence.177 cases presented with distant metastasis,83 cases in the liver,75 in the lung,4 in the brain,15 in the peritoneal,10 in the bone,the other(adrenal metastasis,supraclavicular lymph node metastases)in 8 cases,simultaneously at least two distant metastases had 31 cases;local recurrence and distant metastases occur at the same time had 14 cases.Stage Ⅱ and Ⅲ colorectal cancer relapse with local recurrence,liver metastasis and pulmonary metastasis,compare the primary tumor site(right colon,left colon,middle and upper rectum,lower segment of rectum),the difference is statistically significant(P=0.02).4.2 Local recurrence,liver metastasis and pulmonary metastasis were different between patients with different primary tumor site(P < 0.05),the local recurrence,metastasis to the lungs were prone to occur in these patients with rectal cancer,liver metastasis was prone to occur in patients with colon cancer.4.3 For patients with middle and upper rectum cancer or lower rectum cancer,the local recurrence rate were statistically different(P=0.038);liver metastasis and pulmonary metastasis in these two groups showed no significant difference(P>0.05).4.4 Liver metastasis rate between the right colon cancer and left colon cancer had no statistical difference(P=0.974).Conclusion: Pathological stage,pathological grade and nerve vascular invasion in patients with Ⅱ and Ⅲ colorectal cancer were the assessment marker of DFS.Postoperative adjuvant therapy is beneficial to the prolongation of DFS.Local recurrence was prone to occur in the lower rectal cancer,lung metastasis was pone to occur in patients with rectal cancer,liver metastasis was prone to occur in patients with colon cancer.