Abstract: Objective:To explore the clinicopathological features and prognosis of the obstructive colorectal cancer (CRC).
Methods:The retrospective crosssectional study was conducted. The clinicopathological data of 667 CRC patients who were admitted to the Beijing Friendship Hospital Affiliated to Capital Medical University between January 2013 and December 2015 were collected. The diagnosis and treatment of CRC patients were based on colon cancer and rectal cancer clinical practice guidelines in oncology (Version 2013) of the National Comprehensive Cancer Network (NCCN) and the 7th edition of the American Joint Committee on Cancer (AJCC) cancer staging manual and the future of TNM. CRC and clinical staging were confirmed by colonoscopy, biopsy pathology and CT or MRI examination. Patients selected laparoscopic surgery or open surgery according to their conditions, and then selectively underwent postoperative adjuvant therapy based on the results of pathological examination. Observation indicators: (1) diagnosis and treatment; (2) clinicopathological features; (3) prognosis. Followup using outpatient examination and telephone interview was performed to detect postoperative overall and tumorfree survivals up to April, 2017. Measurement data with normal distribution were represented as ±s and comparison between groups was analyzed using the t test. Count data were described as case and percentage, comparisons between groups were evaluated with the chisquare test. Ordinal data were analyzed using the nonparametric test.
Results:(1) Diagnosis and treatment: tumor locations of 677 patients: tumors located in the right hemicolon, left hemicolon and rectum were respectively detected in 213, 312 and 142 patients. Preoperative clinical staging: 3, 47, 300, 298 and 19 patients were respectively detected in stage 0, Ⅰ, Ⅱ, Ⅲ and Ⅳ. Ninetynine patients were complicated with intestinal obstruction, with an obstructive rate of 14.84% (99/667), and 568 patients didn′t have intestinal obstruction. Treatments of 667 patients: ① Preoperative adjuvant treatment: 17 nonobstructive CRC patients underwent preoperative adjuvant treatments and 650 didn′t undergo preoperative adjuvant treatment. ② Surgical treatment: 389 and 278 patients underwent respectively open and laparoscopic surgeries, and 588 received radical resection and 79 received nonradical resection. (2) Clinicopathological features: of 99 obstructive CRC patients, tumors located in the right hemicolon, left hemicolon and rectum were respectively detected in 26, 61 and 12 patients. Eighteen and 81 patients underwent respectively laparoscopic and open surgeries, including 21 with lowdifferentiated tumors, 61 with moderatedifferentiated tumors and 17 with highdifferentiated tumors; 71 patients received radical resection, with a number of lymph node dissected of 12±9, and 37 , 20 and 14 were respectively detected in stage N0, N1 and N2. Of 568 nonobstructive CRC patients, tumors located in the right hemicolon, left hemicolon and rectum were respectively detected in 187, 251 and 130 patients. Two hundred and sixty and 308 patients underwent respectively laparoscopic and open surgeries, including 38 with lowdifferentiated tumors, 420 with moderatedifferentiated tumors and 110 with highdifferentiated tumors; 517 patients received radical resection, with a number of lymph node dissected of 15±8, and 338, 155 and 24 were respectively detected in stage N0, N1 and N2. There were statistically significant differences in above indicators between obstructive CRC and nonobstructive CRC patients(X²=11.234, 46.505,30.088, Z=-2.782, t=2.942, Z=-2.892, P<0.05). (3) Prognosis: of 667 patients, 584 were followed up for 18-52 months, with a median time of 36 months, including 88 with obstructive CRC (1, 5, 23, 28 and 31 patients were respectively in stage 0, Ⅰ, Ⅱ, Ⅲ and Ⅳ) and 469 with nonobstructive CRC (5, 62, 212, 116 and 101 patients were respectively in stage 0, Ⅰ, Ⅱ, Ⅲ and Ⅳ). During the followup, 56 obstructive CRC patients survived, including 1 in stage 0, 4 in stage Ⅰ, 15 in stage Ⅱ, 17 in stage Ⅲ and 19 in stage Ⅳ, with an overall survival rate of 63.64%(56/88), and overall survival rates in stage 0, Ⅰ, Ⅱ, Ⅲ and Ⅳ were respectively 1/1, 4/5, 65.22%(15/23), 60.71%(17/28) and 61.29%(19/31); 38 had tumorfree survival, including 1 in stage 0, 4 in stage I, 15 in stage Ⅱ, 13 in stage Ⅲ and 5 in stage Ⅳ, with a tumorfree survival rate of 43.18%(38/88), and tumorfree survival rates in stage 0, Ⅰ, Ⅱ, Ⅲ and Ⅳ were respectively 1/1, 4/5, 65.22%(15/23), 46.43%(13/28), 16.13%(5/31). Four hundred and fortythree nonobstructive CRC patients survived, including 5 in stage 0, 58 in stage Ⅰ, 181 in stage Ⅱ, 106 in stage Ⅲ and 93 in stage Ⅳ, with an overall survival rate of 89.31%(443/496), and overall survival rates in stage 0, Ⅰ, Ⅱ, Ⅲ and Ⅳ were respectively 5/5, 93.55%(58/62), 85.38%(181/212), 91.38%(106/116) and 92.08%(93/101); 384 patients had tumorfree survival, including 5 in stage 0, 52 in stage Ⅰ, 166 in stage Ⅱ, 94 in stage Ⅲ and 67 in stage Ⅳ, with a tumorfree survival rate of 77.42% (384/496), and tumorfree survival rates in stage 0, Ⅰ, Ⅱ, Ⅲ and Ⅳ were respectively 5/5, 83.87%(52/62), 78.30%(166/212),81.03%(94/116) and 66.34% (67/101). There were statistically significant differences in overall survival rate and tumorfree survival rate between obstructive CRC and nonobstructive CRC patients (X²=39.626, 43.707, P<0.05). The subgroup analysis: there were statistically significant differences in stage Ⅱ, Ⅲ and Ⅳ overall survival rates between obstructive CRC and nonobstructive CRC patients (X²=6.092，17.027, 11.268, P<0.05) and in stage Ⅲ and Ⅳ tumorfree survival rates (X²=14.148, 24.116, P<0.05).
Conclusion:The obstructive CRC commonly locates in the left hemicolon, with complex clinicopathological features and lowdifferentiated tumors, meanwhile, there are lower radical rate and poor prognosis.