World J Gastroenterol 2006 March 7; 12(9):1458-1462 World Journal of Gastroenterology ISSN 1007-9327 © 2006 The WJG Press. All rights reserved.

PO Box 2345, Beijing 100023, China www.wjgnet.com [email protected]

RAPID COMMUNICATION

Prognostic factors of young patients with colon cancer after surgery Han Liang, Xiao-Na Wang, Bao-Gui Wang, Yuan Pan, Ning Liu, Dian-Chang Wang, Xi-Shan Hao Han Liang, Xiao-Na Wang, Bao-Gui Wang, Yuan Pan, Ning Liu, Dian-Chang Wang, Xi-Shan Hao, Department of Gastrointestinal Oncological Surgery, Tianjin Cancer Hospital, Tianjin Medical University, Tianjin 300060, China Correspondence to: Professor Han Liang, Department of Gastrointestinal Oncological Surgery, Tianjin Cancer Hospital, Tianjin Medical University, Tiyuanbei, Hexi District, Tianjin 300060, China. [email protected] Telephone: +86-22-23340123 Fax: +86-22-23359984 Received: 2005-09-13 Accepted: 2005-10-26

Abstract AIM: To investigate the prognostic factors of 96

invasion, distant metastasis and TNM stage are the predictors of survival in young patients with colon cancer after surgery. © 2006 The WJG Press. All rights reserved.

Key Words: Prognosis; Colon cancer; Young patient;

Surgery

Liang H, Wang XN, Wang BG, Pan Y, Liu N, Wang DC, Hao XS. Prognostic factors of young patients with colon cancer after surgery. World J Gastroenterol 2006; 12(9): 1458-1462

http://www.wjgnet.com/1007-9327/12/1458.asp

young patients with colon cancer within a cancer center by univariate and multivariate analysis.

METHODS: A total of 723 patients with colon cancer

were treated surgically during a period of 10 years. Ninty six of them were 40 years old or younger. R0, R1 and R2 operations were performed in 69 (71.9%), 4 (4.1%) and 23 patients (24%), respectively. Left hemicolectomy was performed in 43 patients, right hemicolectomy in 37 patients, transverse colon resection in 9 patients and low anterior resection in 7 patients. Cox multivariate regression analysis was performed to identify predictors of survival. RESULTS: The operation mortality was 0%, 54

patients died within 111 mo after operation due to occurrence or metastases of the tumor. Liver, lung and bone metastases occurred in 3, 1 and 5 patients, respectively. The mean survival time for all patients was 77.9 ± 5.01 mo and the overall 3-, 5and 10- year survival rates were 66.68%，58.14% and 46.54%, respectively. In the univariate survival analysis, patient age，type of operation, radical resection, blood transfusion, histological type, diameter of tumor, depth of tumor invasion, lymphatic invasion, distant metastases, liver metastases and TNM stage were found to be predictors of survival in young patients with colon cancer. In the Cox-regression analysis, blood transfusion and lymphatic invasion were determined as independent prognostic factors of survival. CONCLUSIONS: Age, type of operation, radical re-

section, blood transfusion, histological type, diameter of tumor, depth of tumor invasion, lymphatic www.wjgnet.com

INTRODUCTION Colorectal cancer is one of the most common malignancies and nearly 600 000 cases are diagnosed annually worldwide [1]. Advances in the management of colon cancer over the past decades have resulted in improvement of the prognosis of this disease. The proportion of early stage (stages I and II) patients has increased from 39.6% to 56.6%, with a corresponding decrease in the proportion of patients with advanced stages, leading to an improvement in five-year relative survival from 33.0% in 1970s to 55.3% in 1990s [2]. The 5-year survival rate is around 60% [3]. Most of the patients with colon cancer are middleaged or older and the peak of morbidity is around 65 years of age [2]. However, young patients are not rare and the incidence of colon cancer in young patients has increased gradually in recent years. We therefore analyzed retrospectively the clinical and pathological characteristics of a large cohort of colon cancer patients (40 years old or younger) treated in a cancer center over a 10-year period to investigate the prognostic factors.

MATERIALS AND METHODS Patients A total of 723 patients with colon cancer were treated between January 1991 and January 2000. All the patients were surgically treated, diagnosed pathologically and included in follow-up procedure. Ninety-six (13.3%) were 40 years old or younger. The cancer was found in the ileocecal junction of 23 patients, in ascending colon of 19 patients, in hepatic flexure of 7 patients, in transverse colon of 11 patients, in splenic flexure of 4 patients, in descending colon

Liang H et al . Prognostic factors in young patients with colon cancer

1459

Table 1 Prognostic factors of young patients with colon cancer after surgery

Items Gender Age Duration of symptoms (m)

Operation

Radical resection Blood transfusion (mL) Pathological type

Diameter of tumor (cm) T

N

M

Male Female ≤30 30-40 ≤1 1-3 3-6 6-12 ≥12 LHC RHC TCR LAR R0 R1 R2 0 400 ≥800 WDAC MDAC PDAC PAC MAC SRCC Others ≤4 4-8 ≥8 T1 T2 T3 T4 N0 N1 N2 M0 M1

Number of cases

AST(m)

58 38 30 66 15 37 25 5 14 43 37 9 7 69 4 23 60 29 7 5 27 18 4 27 3 12 16 53 27 4 10 58 24 45 30 21 75 21

81 ± 6.42 73.62 ± 7.92 49 ± 5.47 82.74 ± 5.76 34 ± 5.28 108 ± 30.25 69 71.80 ± 20.15 80.55 ± 12.34 67 ± 1.95 78 ± 9.00 52 ± 20.99 37 98.2 ± 4.92 32 ± 3.50 24 ± 2.04 85 ± 6.3 69 ± 8.7 31 ± 9.89 92.75 ± 15.80 101.89 ± 7.20 31 ± 3.09 58.75 ± 11.47 60 ± 24.73 23.33 ± 5.39 76 ± 15.11 101.19 ± 9.68 84.02 ± 6.25 31 ± 8.83 111.5 ± 8.06 108 ± 29.54 24 ± 3.13 111.71 ± 3.93 37 ± 2.42 23 ± 2.86 94.59 ± 4.95 24 ± 2.29

3-YSR (%) 69.92 62.48 52.50 73.32 45 77.04 60 53.33 78.57 97.14 83.20 85.71 66.67 87.92 50 6.52 72.59 61.29 35.71 100 88.09 37.50 75 67.73 0 58.33 78.97 76.79 39.16 100 90 82.34 10.33 95 51.85 28.57 84.66 4.76

5-YSR (%)

10-YSR (%)

t

Degree of freedom

61.35 53.69 47.73 63.12 36 67.56 60 53.33 56.25 60.43 62.04 42.86 0 77.67 75 0 64.10 54.08 17.86 75 83.68 31.25 75 46.95 0 58.33 78.97 61.93 39.16 100 90 68.15 91.72 34.90 19.05 73.58 0

45.30 48.32 47.73 49.55 40.04 50 56.25 10.34 15.75 0 0 63.40 75 0 59.17 38.93 75.32 31.30 0 58.33 78.97 48.38 100 90 38.94 78.62 29.08 61.45 0

0.46

1

0.499

2.4

1

0.0387

5.33

4

0.2553

9.43

3

0.0241

80.72

2