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術前臨床的に病理学的T3期と診断されたT3およびT4結腸癌患者の臨床的特徴と腫瘍学的転帰
Clinical characteristics and oncologic outcomes in patients with preoperative clinical T3 and T4 colon cancer who were staged as pathologic T3.
PMID: 32676480 PMCID: PMC7332321. DOI: 10.4174/astr.2020.99.1.37.
抄録
目的:
術前検査で臨床的にT4期結腸癌が疑われた場合，術後に病理学的にT3期結腸癌と診断されることが多く，過小評価が懸念される．本研究の目的は，術後に病理学的にT3期と診断された臨床的T3期結腸癌患者とT4期結腸癌患者の生存期間を比較することであった。
Purpose: Clinically suspected T4 stage colon cancer from a preoperative exam is often diagnosed as T3 stage colon cancer pathologically after surgery, raising concerns about understaging. The aims of this study were to compare the survival of clinical T3 and T4 colon cancer patients who had received a pathologic T3 stage diagnosis postoperatively.
方法:
術後に病理学的T3期結腸癌と診断された患者をレビューした。術前検査で臨床的にT3期またはT4期の結腸癌が疑われた患者を本研究に登録した。患者の人口統計学とcT3群とcT4群の生存率を比較した。
Methods: Patients who were diagnosed with pathologic T3 stage colon cancer postoperatively were reviewed. Patients with clinically suspected T3 or T4 stage cancer on preoperative exam were enrolled in the study. We compared patient demographics and survival of the cT3 and cT4 groups.
結果:
pT3結腸癌536例のうち、術前は503例がcT3（93.8％）、33例がcT4（6.2％）であった。臨床的にT4期癌が疑われた理由として最も多かったのは遊離穿孔（78.8％）であった。5年全生存期間と全5年無病生存期間（DFS）は、cT3群とcT4群で統計学的に有意な差はなかったが、局所再発はcT4群で有意に高かった（局所5年DFS：98.6％ vs. 84.0％、P＜0.001）。多変量解析では、cTステージは局所再発と関連していたが、関連は統計的に有意ではなかった（P = 0.056）。
Results: Out of the 536 patients with pT3 colon cancer, 503 patients were cT3 (93.8%) and 33 patients were cT4 (6.2%) preoperatively. The most common reason for suspected clinical T4 stage cancer was free perforation (78.8%). There were no statistically significant differences between the 5-year overall survival and the total 5-year disease-free survival (DFS) between the cT3 and cT4 groups; however, local recurrence was significantly higher in the cT4 group (local 5-year DFS: 98.6% vs. 84.0%, P < 0.001). Multivariate analysis showed cT stage was associated with local recurrence, but the association was not statistically significant (P = 0.056).
結論:
術前に臨床的にT4期が疑われた結腸癌では、術後に病理学的にT3期と診断されたにもかかわらず、局所再発が劣っていた。T4期結腸癌の過小評価に関する病理学的検査の欠点を改善し、cT4期結腸癌患者の局所制御のための治療を強化する必要がある。
Conclusion: Preoperative clinically suspected T4 stage colon cancer showed inferior local recurrence despite a postoperative pathologic diagnosis of T3 stage cancer. It is necessary to address the shortcomings of pathologic exams in the matter of the understaging of T4 colon cancer, and to reinforce the treatment for local control in patients with cT4 colon cancer.
Copyright © 2020, the Korean Surgical Society.