The Prognostic Significance of Tumor Location and Bowel Obstruction in Dukes B and C Colorectal Cancer

Abstract

The present study examines the prognostic significance of tumor location and bowel obstruction in Dukes B and C colorectal cancer. Data were obtained from 1021 patients entered into two randomized prospective clinical trials of the NSABP. Tumor location proved to be a strong prognostic discriminant. Lesions located in the left colon demonstrated the most favorable prognosis. Tumors of the rectosigmoid and rectum had the worst prognosis with the relative risk of treatment failure for the latter being over three fold that of the left colon. When the relative risks associated with tumor location were adjusted for nodal imbalances, the left colon continued to demonstrate the most favorable prognosis. The presence of bowel obstruction also strongly influenced the prognostic outcome. Examination of the data without considering tumor location disclosed that patients with bowel obstruction were at greater risk for treatment failure than those without obstruction. The effect of bowel obstruction was influenced by the location of the tumor. The occurrence of bowel obstruction in the right colon was associated with a significantly diminished disease-free survival, whereas obstruction in the left colon demonstrated no such effect. This phenomenon was independent of nodal status and tumor encirclement, the latter two factors proving to be of prognostic significance independent of tumor obstruction. A multivariate analysis in which the covariate effects of sex, age, nodal status, tumor obstruction, encirclement, and tumor location were adjusted underscored the role of tumor location and obstruction as prognostic discriminants. The results indicate that the definition of prognostic factors can identify patient subsets with unique characteristics.

Colorectal carcinoma in poor blacks

“…21,[22][23][24]29,32,33,35,37,38 The 5-year survival rates for patients with Stage I and II colorectal carcinoma were lower than those in SEER data but similar to those reported in the National Cancer Data Base. 32 Increasing evidence suggests that with equal access to the same modalities of treatment there is equal outcome regardless of race in breast, 41,42 prostate, 43,44 cervical, 45 and childhood cancer.…”

“…Whether this "proximal migration" is because of evolution in the biology of the colorectal carcinoma or an artifact of more frequent and more extensive access to the proximal bowel via endoscopic approaches remains to be documented. 32 Although surgery is considered the most effective therapy for colorectal carcinoma, 26,29 only 311 patients (50.6%) underwent surgery with the intention of cure. Ninety-two patients (15%) had no treatment, much higher than previous reports.…”

Tumour markers of prognosis in colorectal cancer

“…The prognosis for this cancer is influenced by a variety of features present at the time of initial diagnosis. These factors include age, gender, duration of symptoms, presence of bowel obstruction, tumour location, need for blood transfusion and the quality of surgical intervention (Wolmark et al, 1983;McArdle and Hole 1991;Hermanek et al, 1995). A number of tumour characteristics, such as vascular and lymphatic invasion, ploidy, differentiation and preoperative levels of plasma carcinoembryonic antigen, have also been shown to be of prognostic significance (Witzig et al, 1991;Hermanek et al, 1995).…”

Proposta para estadiamento do câncer colorretal baseada em critérios morfofuncionais: correlação com níveis séricos do antígeno carcinoembrionário

“…6 ,7 Estudos têm sido publicados correlacionando variáveis clínicas e histopatológicas ao prognóstico do CCR, mas seus resultados são intrigantes e muitas vezes conflituosos. 8 ,9 O diagnósti-co precoce, 10 a idade, 11 localização da neoplasia, 12 graduação histológica, 13 grau de penetração na parede intestinal, 14 comprometimento linfonodal, 15 produção de muco pela neoplasia, 16 antígeno carcinoembrionário (CEA), 17 invasão venosa e neural 18 são as variáveis mais freqüentemente estudadas, como fatores relacionados ao prognóstico da enfermidade. Estudos foram realizados com o intuito de discriminar o poder prognóstico independente das principais variáveis relacionadas ao CCR.…”