The Prognostic Impact of Endoscopic Obstruction on Colorectal Cancer
Korean Journal of Clinical Oncology
Purpose : The objective of this study was to evaluate pre-operative chemotherapy of efficacy for breast cancer and re-assessment of breast U/S as modality to test response rate. It was to review correlations the findings of ultrasonography (US) and magnetic resonance (MR) imaging in patients Methods : retrospective review identified Ninety-three patients who underwent pre-operative chemotherapy between July, 1996 and December, 2004 were included for this study. We analysed the response rate to
... e response rate to adjuvant chemotherapy by reviewing the post operative pathologic report. All patients was performed US after preoperative chemotherapy, and 26 (27.9%) patients was perfomed both US and MRI to compare pre-operation tumor size by U/S and MRI with the post operative pathologic report s tumor sizes. Statistical analyses were performed with 2-tests and using SPSS 13.0. Results : The mean age at diagnosis was 46.98(22-74)yrs old. Pre-operation clinical stage was 4 patients for stage I, 40 patients for stage II, 47 patients for stage III and 2 patinets for stage IV. And the tumoral response to preoperative chemotherapy as, 7 patients showed a complete response (CR), 52 patients showed a partial response (PR),24 patients showed a stable disease(SD), and 10 patients showed a progressive disease(PD). Each 5 years overall survival rate were 85.8%, 92.3% ,95.8%, 90.0%.The correlation coefficient (r) of US to pathological tumor size was 0.910 in all tumors, The correlation coefficient (r) of MRI to pathological tumor size was 0.860 in all tumors . (P<0.05) Conclusions : This study results were similar to other published current studies for neoadjuvant chemotherapy for breast cancer. The correlation between tumor size in U/S and pathological tumor size corresponded best. So it doesn t need to perfomed MRI for all patients to evaluate response rate. Breast U/S considered as optional modality to evaluate response. Abstract Purpose : The colorectal cancer has better prognosis rather than other gastrointestinal malignancy by the development of operation procedure and adjuvant therapy. But the high-risk patients have a high recurrence rate and a poor prognosis, so more interest and the development of new treatment modality for high-risk patients is needed. Now some high-risk factors of the colorectal cancer -lymph node metastasis and lymphatic/vascular invasion -were difficult to estimate preoperatively. The colon obstruction is considered to be a factor which is predictable preoperatively and helpful for patient. There were fewer studies about oncologic outcome of partial or endoscopic colon obstruction than complete colon obstruction, so we investigate the prognostic impact of endoscopic obstruction on colorectal cancer. Materials and Methods : Retrospective analysis of 317 patients with surgically resected stage II and III colorectal cancer in Korea Uinversity Guro Hospital from 1 st January 2003 to 31 st December 2006 was performed for preoperative colon obstruction and postoperative prognosis. Statistical analysis was performed using SPSS 12.0. Chi-square test and t-test were used for comparing each variables. OS analysis was performed using Kaplan-Meier curves with log-rank testing. P < 0.05 was considered statistically significant. Result : Gender (Male : Female) of whole patients was 1.4:1. Mean age was 62.0(year). Comparison of clinical features and pathologic findings according to the presence of obstruction demonstrated a significant difference in size, location, infiltration, and preoperative CEA (carcinoembryogenic antigen), yet showed no major differences in age, sex, the timing of surgery, and lymph node metastasis. When the left colon was compared with the right colon while excluding the rectum, difference was found between the sizes of the tumor, but no difference was found in the presence of obstruction. According to the comparison based on the shape of the tumor, 41.1% of the obstructive colon cancer was infiltrating or encircling, and these findings were observed in 23.4% of nonobstructive colon cancer (p<0.05). There were 69 recurrences during the monitoring, and the 5-year diseasefree survival rate for stage II and stage III were 85.5% and 70.7%, respectively. Comparing the disease-free survival rate according to the location of the lesion and presence of obstruction, it showed no difference in stage III colon and rectal cancer, but a significant difference was found in stage II rectal cancer. When compared according to the types of obstruction, the 5-year disease-free survival rates for no obstruction, endoscopic obstruction, and complete obstruction were 77.2%, 70.9%, and 67.1%, respectively. There were no differences between them. Conclusion : Endoscopic obstruction is a significant risk factor for recurrence in stage II rectal cancer compared to colon cancer and for those patients, adjuvant treatment such as pre-operative radiotherapy is needed.