Analysis of clinicopathological characteristics and survival of simultaneous multiple primary colorectal cancer

doi:10.3877/cma.j.issn.1674-0785.2021.11.007

Abstract

Abstract:

Objective

To investigate the clinicopathological features and long-term survival prognosis of synchronous colorectal carcinoma (sCRC).

Methods

This is a single center retrospective, case-control study to screen the retrospective data cohort of colorectal cancer (CRC) at the Fourth Hospital of Hebei Medical University from January 2017 to December 2019. According to the inclusion and exclusion criteria, 79 patients with multiple primary CRC and 158 patients with single primary CRC were randomly matched at 1∶2 in this cohort. General data, surgical information, complications, lesion distribution, pathological data, and molecular markers were compared between the two groups to screen the characteristic variables of sCRC. The survival outcomes (overall survival [OS] and progression-free survival [PFS]) were recorded and compared between the two groups. Subgroup analysis was also performed.

Results

(1) In the multiple primary CRC group, the percentages of patients with adenoma (χ²=22.937, P＜0.001), male patients (χ²=6.722, P=0.010), and those with hypoproteinemia (χ²=10.621, P=0.001), anemia (χ²=13.709, P＜0.001), incomplete colonoscopy (χ²=12.253, P＜0.001), and microsatellite instability (MSI) (χ²=14.719, P=0.001) were higher than those in the single primary CRC group. There were no significant differences in gender, age, BMI, family history, CEA, operation mode, anastomotic leakage, intestinal obstruction, TNM stage, lymph node metastasis, vascular tumor thrombus, nerve invasion, KRAS status or BRAF status between the two groups (P＞0.05). (2) There were 68 cases with double lesions, 10 with three lesions, 1 with four lesions in sCRC, including 50 lesions in the right colon (29.41%) and 120 lesions in the left colon (70.59%). Compared with the single primary CRC group (17.72% of lesions in the right colon and 82.28% in the left colon), the proportion of lesions in the right colon in the multiple primary CRC group was significantly higher in the multiple primary CRC group (χ²=6.174, P=0.013). (3) The median follow-up time was 23.1 months, with 7 cases (2.95%) lost to follow-up. The 1-, 2-, and 3-year survival rates were 96.0%, 90.6%, and 87.5% in the multiple primary CRC group, and 94.6%, 87.5%, and 84.6% in the single primary CRC group; there was no significant difference between the two groups (P=0.76). The PFS interval was 0-44.5 months, with an average of 20.6 months. There was no significant difference in PFS between the two groups (P=0.14). (4) Subgroup analysis showed that there was no significant difference in OS among subgroups (P＞0.05). In the multiple primary CRC group, PFS in the multiple adenoma subgroup (hazard ratio [HR]=0.34, 95% confidence interval [CI]: 0.12-0.96, P=0.042), stages 0-Ⅱ subgroup (HR=0.20, 95%CI: 0.05-0.76, P=0.019), and stage Ⅳ subgroup (HR=0.15, 95%CI: 0.04-0.66, P=0.012) were worse than that of the single primary CRC group.

Conclusion

sCRC is characterized by adenoma, hypoproteinemia, anemia, male predisposition, high proportion of incomplete colonoscopy, and high proportion of MSI. The tumor is often located in the right colon. There is no difference in OS and PFS between sCRC and single primary CRC, but PFS may be worse in sCRC patients with multiples adenoma and stage 0-Ⅱ and stage Ⅳ disease.

Key words: Multiple primary, Colorectal cancer, Pathological features, Overall survival, Disease free survival

Xuhua Hu, Miao Yu, Penghui Liu, Jianfeng Zhang, Baokun Li, Xiaoran Wang, Ganlin Guo, Bin Yu, Zhenya Zhang, Guiying Wang. Analysis of clinicopathological characteristics and survival of simultaneous multiple primary colorectal cancer[J]. Chinese Journal of Clinicians(Electronic Edition), 2021, 15(11): 833-841.

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Figures/Tables 6

项目	多原发组（79例）	单原发组（158例）	统计值	P值
年龄（岁， $x ¯$ ±s）	61.23±12.59	59.70±12.01	t=0.910	0.364
BMI（kg/m²， $x ¯$ ±s）	24.03±4.02	24.32±3.42	t=-0.588	0.557
性别［例（%）］			χ²=6.722	0.010
男	60（75.95）	93（58.86）
女	19（24.05）	65（41.14）
合并腺瘤［例（%）］			χ²=22.937	＜0.001
否	25（31.65）	102（64.56）
是	54（68.35）	56（35.44）
合并家族史［例（%）］			χ²=2.084	0.149
否	61（77.22）	134（84.81）
是	18（22.78）	24（15.19）
CEA（ng/L， $x ¯$ ±s）	16.11±32.92	24.25±90.72	t=-0.772	0.441
CEA≥5 ng/L［例（%）］			χ²=0.416	0.519
否	40（50.63）	87（55.06）
是	39（49.37）	71（44.94）
白蛋白＜35 g/L［例（%）］			χ²=10.621	0.001
否	43（54.43）	119（75.32）
是	36（45.57）	39（24.68）
贫血［例（%）］			χ²=13.709	＜0.001
否	40（50.63）	118（74.68）
是	39（49.37）	40（25.32）
完成结肠镜检查［例（%）］			χ²=12.253	＜0.001
否	33（41.77）	32（20.25）
是	46（58.23）	126（79.75）

项目	多原发组（79例）	单原发组（158例）	统计值	P值
年龄（岁， $x ¯$ ±s）	61.23±12.59	59.70±12.01	t=0.910	0.364
BMI（kg/m²， $x ¯$ ±s）	24.03±4.02	24.32±3.42	t=-0.588	0.557
性别［例（%）］			χ²=6.722	0.010
男	60（75.95）	93（58.86）
女	19（24.05）	65（41.14）
合并腺瘤［例（%）］			χ²=22.937	＜0.001
否	25（31.65）	102（64.56）
是	54（68.35）	56（35.44）
合并家族史［例（%）］			χ²=2.084	0.149
否	61（77.22）	134（84.81）
是	18（22.78）	24（15.19）
CEA（ng/L， $x ¯$ ±s）	16.11±32.92	24.25±90.72	t=-0.772	0.441
CEA≥5 ng/L［例（%）］			χ²=0.416	0.519
否	40（50.63）	87（55.06）
是	39（49.37）	71（44.94）
白蛋白＜35 g/L［例（%）］			χ²=10.621	0.001
否	43（54.43）	119（75.32）
是	36（45.57）	39（24.68）
贫血［例（%）］			χ²=13.709	＜0.001
否	40（50.63）	118（74.68）
是	39（49.37）	40（25.32）
完成结肠镜检查［例（%）］			χ²=12.253	＜0.001
否	33（41.77）	32（20.25）
是	46（58.23）	126（79.75）

项目	多原发组（79例）	单原发组（158例）	χ²值	P值
根治性手术［例（%）］				0.029	0.866
否		6（7.60）	13（8.23）
是		73（92.41）	145（91.77）
肿瘤部位^a				6.174	0.013
左半结肠^b［例（%）］		120（70.59）	130（82.28）
	直肠（例）	44	-
	乙状结肠（例）	50	-
	降结肠（例）	15	-
	远端1/3横结肠（例）	11	-
右半结肠［例（%）］		50（29.41）	28（17.72）
	近端2/3横结肠（例）	16	-
	升结肠（例）	28	-
	盲肠（例）	6	-
肠梗阻^c［例（%）］				3.213	0.073^d
是		6（7.89）	3（1.99）
否		70（92.11）	148（98.01）
吻合口漏^c［例（%）］				-	0.429^e
是		1（1.32）	6（3.97）
否		75（98.68）	145（96.03）

项目	多原发组（79例）	单原发组（158例）	χ²值	P值
TNM分期^a			3.594	0.309
0~I期	6（7.60）	23（14.56）
Ⅱ期	42（53.16）	67（42.41）
Ⅲ期	25（31.65）	55（34.81）
Ⅳ期	6（7.59）	13（8.23）
淋巴结转移			4.731	0.193
N0	48（60.76）	92（58.23）
N1	17（21.52）	21（13.29）
N2	8（10.13）	26（16.46）
未知	6（7.59）	19（12.02）
脉管瘤栓			1.029	0.598
否	54（68.35）	102（64.56）
是	19（24.05）	47（29.75）
未知	6（7.59）	9（5.70）
神经受侵			1.789	0.409
否	53（67.09）	100（63.29）
是	19（24.05）	49（31.01）
未知	7（8.86）	9（5.70）
MSI状态			14.719	0.001
MSS	46（58.23）	121（76.58）
MSI	17（21.52）	9（5.70）
未知	16（20.25）	28（17.72）
BRAF状态			-	1.000^b
野生型	77（97.47）	153（96.84）
突变型	2（2.53）	5（3.16）
KRAS状态			1.151	0.562
野生型	37（46.84）	78（49.37）
突变型	32（40.51）	54（34.18）
未知	10（12.66）	26（16.46）

项目	例数	OS		PFS
项目	例数	HR值（95%CI）	P值^a	HR值（95%CI）	P值^a
年龄
＜60岁	86	0.57（0.14，2.43）	0.452	0.52（0.18，1.48）	0.220
≥60岁	144	1.66（0.54，5.09）	0.377	0.73（0.35，1.52）	0.400
性别
男	150	1.68（0.61，4.64）	0.315	0.73（0.36，1.49）	0.385
女	80	0.42（0.07，2.52）	0.341	0.53（0.18，1.58）	0.253
合并腺瘤
否	123	1.55（0.35，6.77）	0.563	0.73（0.29，1.81）	0.493
是	107	0.52（0.12，2.17）	0.367	0.34（0.12，0.96）	0.042
CEA≥5 ng/L
否	126	0.95（0.25，3.70）	0.944	0.47（0.21，1.08）	0.077
是	104	1.32（0.42，4.16）	0.637	0.90（0.38，2.15）	0.809
贫血
否	153	1.28（0.36，4.49）	0.701	0.86（0.36，2.02）	0.725
是	77	0.93（0.23，3.73）	0.922	0.38（0.13，1.10）	0.075
白蛋白＜35 g/L
否	159	1.32（0.37，4.64）	0.669	0.71（0.33，1.56）	0.396
是	71	1.11（0.30，4.16）	0.873	0.51（0.18，1.44）	0.201
完成结肠镜检查
否	63	1.00（0.20，4.95）	0.999	0.92（0.37，2.33）	0.867
是	167	1.17（0.39，3.54）	0.780	0.61（0.27，1.37）	0.232
TNM分期
0~Ⅱ期	135	0.14（0.01，1.37）	0.091	0.20（0.05，0.76）	0.019
Ⅲ期	79	1.41（0.39，5.10）	0.599	1.30（0.52，3.28）	0.572
Ⅳ期	16	2.62（0.31，21.83	0.374	0.15（0.04，0.66）	0.012
脉管瘤栓
否	195	0.84（0.26，2.74）	0.771	0.56（0.28，1.15）	0.116
是	23	1.97（0.38，10.14	0.420	3.16（0.35，28.34）	0.304
未知	12	2.26（0.25，20.51	0.468	0.37（0.08，1.68）	0.197
神经受侵
否	153	0.44（0.11，1.77）	0.246	0.59（0.24，1.43）	0.242
是	65	1.93（0.42，8.81）	0.398	0.90（0.32，2.52）	0.835
未知	12	2.26（0.25，20.51）	0.468	0.37（0.08，1.68）	0.197

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