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Lymphangiosis as a Predictor of Outcome in Patients With Primary Diffusely Infiltrative Adenocarcinoma of the Colon and Rectum
Reiping Tang, MD;
Jeng-Yi Wang, MD;
Kuo-Chien Tsao, BS;
Yat-Sen Ho, MD
Arch Surg. 1999;134:157-160.
Objective To investigate the relationships between outcome and clinicopathological factors, DNA flow cytometrical characteristics, and postoperative adjuvant therapy in patients with primary diffusely infiltrative colorectal adenocarcinoma.
Design Inception cohort study.
Setting A medical center that offers a mixture of primary, secondary, and tertiary care services.
Patients Among 7035 patients undergoing resection of primary colorectal adenocarcinoma from 1980 to 1996, 37 patients with a pathological diagnosis of primary diffusely infiltrative tumor were selected. All patients had received regular follow-up until February 28, 1998, or until death.
Main Outcome Measures Cancer-specific survival compared by log-rank test and Cox regression model.
Results Univariate analyses revealed tumor stage (stages II-III vs stage IV, P=.01) and severity of lymphangiosis (absent/mild vs moderate/severe, P=.04) were significant in predicting outcome. A proliferative index of greater than 20% was insignificant (P=.08) in predicting outcome. In a Cox regression model, TNM stage and lymphangiosis were independently correlated with a worse outcome. When compared with tumors having less severe lymphangiosis, the odds ratio of death due to cancer in cases of tumors with moderate to severe lymphangiosis was 2.4 (95% confidence interval, 1.0-5.6; P=.05).
Conclusion Lymphangiosis and TNM stage were independently predictive of outcome in patients with primary diffusely infiltrative colorectal cancer.
From the Departments of Colorectal Surgery (Drs Tang and Wang) and Pathology (Drs Tsao and Ho), Chang Gung Memorial Hospital, Taipei, Taiwan.
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