PROGNOSTIC CRITERIA OF RECURRENCE AND FATAL OUTCOME OF PATIENTS WITH COLORECTAL CARCINOMA
Colorectal cancer (CRC) is the second leading cause of mortality among cancers. Among men in Ukraine at 2018, the mortality rate for CRC was 13,2% following after cancers of lung, and among women - 15.3% following after cancers of breast. The recurrences of CRC appear in 30-40% of cases and might be characterized by rapid generalization of tumor process. The stage according to TNM system is the strongest predictor of postoperative outcome, also other clinical, histologic, molecular and genetic features may influence prognosis independent of stage. The detection of recurrences at the earliest asymptomatic stage makes it possible to prescribe timely treatment. The individualized approach to the treatment of patients with CRC should also be based on searching for prognostic criteria of disease.
The aim of this research: to find the prognostic criteria of recurrence and lethal outcome of CRC according to the data of morphological research of material, which are surgically removed, and autopsy.
Material and methods. It was analyzed 321 autopsies and material of CRC after surgical removal, which were done in the pathological anatomy department of Kharkiv City Hospital N17 between January 2010 and September 2020. It was formed two research groups based on histological examination of the primary tumors, observation data, and autopsy records. The group I was formed from primary tumors, which were removed, without recurrences and without fatal outcome during 5 years after surgical removal (n=20). The group II – CRR with recurrences (40 cases), without fatal outcome (IIA) (n=20), and with fatal outcome from generalization of tumor process (IIB) (n=20). The cases of stage III (by TNM system) with invasion through muscular layer into peri-intestinal fat tissue without growth through serosa and absence of metastases in the visceral organs were selected.
Results. Local recurrences were in 12.5% of primary CRC, stage III, T3 (by TNM system). The average time of postoperative recurrence among patients of two groups was 18±8,6 months, recurrences in 70.0% (28/40) were in the first 2 years. Also, recurrences in 82.5% were represented by metastases to visceral organs, recurrences in 5% of cases were both local and with metastases to visceral organs. It was found statistically significant association (p<0,05) between CRC which belong to group II of research and presence of such features as: metastasis in regional lymph nodes, vascular invasion, absence of adjuvant therapy, shorter distance to the resection margins, which indicates the prognostic value of these factors for prediction of recurrence after tumor resection. Among reccurrent cancers fatal outcome from tumor generalization was associated with: metastasis in regional lymph nodes in the surgicaly removal of primary tumor material (p<0.03), absence of neoadjuvant chemotherapy (p<0.05), early recurrence (within 2 years) (p<0.05), recurrence with presence of local and distant focuses at the same time (p<0.05). We did not find prognostic value for such clinical and pathological features as: age and patients` sex, localization of primary tumor and their size more or less than 5 sm, perineural invasion.
Conclusions. As a results of research of primary CRC stage III with T3 level of invasion revealed prognostic criteria for recurrence and fatal outcome, which should be recommended for individualized approach in treatment of patients.
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