Clinical Pathology And Multivariate Regression Analysis On Prognosis In Colorectal Cancer With Tumour Deposits

Objective: To study clinicopathology of noduled colorectal cancer and factorsaffecting itsprognosis, in order to provide guidance for choice of clinical treatmentand to improve prognosis.Methods: Retrospective method was used, patients who underwent surgery fromJun.12006to Jun.12011in the Chenzhou First People’s Hospital and who wasdiagnosed with TD(tumor deposit) colorectal cancer were selected as study subjects.Their clinicopathological data were collected including age, gender, tumor location,tumor size, gross morphology, intestinal obstruction, intestinal perforation,histological type, degree of differentiation, T staging, N staging, TNM staging,vascular infiltration, perineural invasion, CEA, CA19-9, choice of surgical procedure,chemotherapy, perioperative blood transfusion, number and size of malignant nodules.These patients were followed up, the beginning was set at day of operation and theending was set at Dec.312012or the day of patient’s death, lost or last follow-up.Statistical analysis on these data was made using SPSS13.0to describe patients’clinicopathological features; survival rate was calculated by Kaplan-Meier estimateand was compared between groups by Log-rank test; independent prognostic factorsof noduled colorectal cancer were determined by multivariate analysis using Coxregression model. P<0.05were considered significant.Results:1.Clinicopathological featurescolorectal cancer with TD accounts for14.9%of all colorectal cancer of thesame phase. Of the100patients included in this study,52were male and48female;the oldest was82years old and the youngest18years old;18patients were less than40years old,55were between40-65years old and the other27were more than65 years old. Tumor location: proximal colon,23cases; distal colon,18cases; rectum,59cases. Tumor size: maximum,13cm; minimum,2.2cm;<5cm,58cases;≥5cm,42cases. Gross phenotyping: mass type,7cases; ulcerative,50cases, infiltrative,43cases. Histological typing, adenocarcinoma,81cases; mucinous adenocarcinoma,16cases; carcinoid,3cases. Differentiation stage: highly differentiated,2cases;moderately differentiated,66cases; lowly differentiated,29cases; others (carcinoid),3cases. T staging: T2,6cases; T3,11cases; T4,83cases. N staging: N1,50cases;N2,50cases. TNM staging: TNM III,69cases; TNM IV,31cases.31cases showeddistant metastasis,9cases showed vascular infiltration and8cases showed perineuralinvasion.40cases had elevated serum CEA before surgery and the other60werenormal;31cases had elevated CA19-9and the other69were normal.74had radicalsurgery and the other26had palliative surgery. Patients had1-8cancerous nodules,55of them had less than3. The nodules had1.0-9.0mm diameter with an average of4.2mm,62subjects had nodules less than5mm. Patients’ survival time was8-68months with an average of33.43months,1-year,2-year, and3-year overall survivalrates were66.0%,27.0%,6.0%, respectively.2. Prognostic Analysis2.1Univariate analysis showed that age, gender, tumor location, tumor size, grosstype, intestinal obstruction, intestinal perforation, histological type, tumor Grade, Tstaging, N staging, TNM staging, vascular infiltration, perineural invasion, CEA,CA19-9, surgical, chemotherapy, perioperative blood transfusion, number and size ofTD were prognostic factors.2.2Cox regression analysis showed that tumor location, gross type, histologicaltyping, perineural infiltration, TNM staging, surgical,chemotherapy, number of TDwere independent prognostic factors of colorectal cancer with TD.Conclusion：1. The most gross type of colorectal cancer with TD was ulcerative, infiltrative type isalso commonly seen.2. Histologically, colorectal cancers had TD are mainly adenocarcinoma, and mucino- us adenocarcinoma, signet ring cell carcinoma accounts for relatively high proportion.3. Most colorectal cancers had TD are moderately differentiated and lowlydifferentiated, and few were highly differentiated.4. Noduled colorectal cancers are in late stages, that is, stage III or IV, and thus havevery low rate of surgical cure and poor prognosis.5. Tumor location, gross type, histological type, perineural infiltration, TNM staging,surgical, chemotherapy, number of TD were independent prognostic factors of colore-ctal cancer with TD.