Analysis Of Related Factors Of Stage Ⅲ Colorectal Cancer Recurrence And Metastasis After Radical Resection

Objective: To explore the related factors of stage Ⅲ colorectal cancer recurrence and metastasis.Methods: A total of 311 patients with stage Ⅲ colorectal cancer in the Affiliated Drum-Tower Hospital of Nanjing University Medical School from March 2010 to July 2016 were choosen.Patients’ clinical pathological parameters,preoperative tumor markers,adjuvant chemotherapy were collected.Independent prognostic factor of DFS in stage Ⅲ colorectal cancer was analyzed by univariate analysis and multivariate analysis.To explore risk factors of the type of recurrence and metastasis(single organ distant metastasis,local recurrence,and multiple metastasis)and recurrence time(DFS < = 12 months and DFS > 12 months),further analysis was performed on 122 patients with metastatic colorectal cancer from 311 patients.Results: This study included 311 patients with stage Ⅲ colorectal cancer.Univariate analysis showed that etiology(p=0.023),operation method(p=0.009),the degree of differentiation(p<0.001),T staging(p<0.001),number of positive lymph nodes(p<0.001),pathologic stage(p<0.001),expression level of CEA(p=0.008),expression level of CA125(p=0.003),expression level of CA199(p=0.001)and timing of adjuvant chemotherapy(p=0.039)and adjuvant chemotherapy cycle(p<0.001)were accosiated with DFS in stage Ⅲ colorectal cancer.Multivariate analysis showed that etiology(intestinal obstruction or bowel perforation,HR,7.157,95% CI 2.737-18.714,p<0.001),degree of differentiation(poor differentiation,HR,2.284,95% CI 1.384-3.769,p=0.01;mucinous adenocarcinoma,HR,2.153,95% CI 1.090-4.250,p=0.027),T staging(T4,HR,4.388,95% CI 1.090-4.250,p<0.001),number of positive lymph nodes(>3,HR,1.853,95% CI 1.156-2.969,p=0.010),expression level of CEA(CEA>10ng/ml,HR,2.317,95% CI 1.359-3.949,p=0.002),timing of adjuvant chemotherapy(4-8weeks,HR,0.557,95% CI 0.330-0.939,p=0.028),and adjuvant chemotherapy cycle(4-6 cycles,HR,0.377,95% CI 0.172-0.828,p=0.015;6-8 cycles,HR,0.192,95% CI 0.120-0.309,p<0.001)were the independent prognostic factors of DFS in patients with stage Ⅲ colorectal cancer.122 patients with metastatic colorectal cancer from 311 cases were divided into three groups: single organ distant metastasis,local recurrence,and multiple metastasis.Local recurrence is more likely to appear in mucinous adenocarcinoma than single organ distant metastasis(p<0.001).Recurrence time was divided into two groups: DFS < = 12 months and DFS > 12 months.Univariate analysis showed that operation method(p=0.015),degree of differentiation(p<0.001),expression level of CA199(p=0.002),adjuvant chemotherapy cycle(p<0.001)were related to recurrence time.Multivariate analysis showed that poor differentiation(OR,26.730,95% CI 5.505-129.787,p<0.001),T4(OR,20.451,95% CI 1.721-243.059,p=0.017),6 cycles and above of adjuvant chemotherapy(OR,0.120,95% CI 0.028-0.508,p=0.004),CA199 > 27 u/ml(OR,12.722,95% CI 2.223-72.801,p=0.004)were the independent factors of DFS<=12 months.Conclusion: etiology,differentiation degree,T staging,number of positive lymph nodes,expression level of CEA,timing of adjuvant chemotherapy and adjuvant chemotherapy cycle are independent prognostic factors of DFS in stage Ⅲ colorectal cancer.Local recurrence is more likely to occur in mucinous adenocarcinoma than single organ distant metastasis(p<0.001).The degree of differentiation,T staging,adjuvant chemotherapy cycle and expression level of CA199 are independent factors of recurrence time.