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결장 및 직장 점액암의 임상 양상

Clinical Study of Mucinous Colorectal Carcinoma

대한대장항문학회지 2001년 17권 2호 p.97 ~ 102
안창혁 ( An Chang-Hyeok ) - 가톨릭대학교 의과대학 외과학교실

강원경 ( Kang Won-Kyung ) - 가톨릭대학교 의과대학 외과학교실
박승철 ( Park Seung-Cheol ) - 가톨릭대학교 의과대학 외과학교실
홍민광 ( Hong Min-Kwang ) - 가톨릭대학교 의과대학 외과학교실
이도상 ( Lee Do-Sang ) - 가톨릭대학교 의과대학 외과학교실
오승택 ( Oh Seung-Tack ) - 가톨릭대학교 의과대학 외과학교실
전해명 ( Jeon Hae-Myung ) - 가톨릭대학교 의과대학 외과학교실

Abstract


Purpose: The clinical influences of mucinous colorectal carcinomas are still controversial. Some previous reports have suggested that mucinous carcinomas of colorectum affect more young patients, involve the more proximal colon, are more advanced at diagnosis, show increased incidence of local and distant metastasis, and have a worse prognosis than adenocarcinoma. We evaluated the clinicopathological aspect of mucinous colorectal carcinoma.

Methods: A retrospective review of colorectal cancer patients treated between January 1990 and December 1998 was undertaken. Eight-hundred-fifty patients were operated for colorectal cancer during the period, among them seven- hundred-eighty-two patient records were available for this study. Sixty-two patients (7%) could be classified as mucinous carcinoma as defined by more than 50% of mucin- secreting pattern on histological examination. The age and sex distribution, primary location of tumor, modified Dukes’ classification at diagnosis, recurrence rates and 5-year survival of mucinous carcinoma patients were compared with those of adenocarcinoma patients. Survival was calculated according to Kaplan-Meyer, and the differences were compared using the log-rank test.

Results: The sex ratio of mucinous carcinoma was 2.05:1, whereas 1.32:1 in adenocarcinoma. The age distribution of mucinous carcinoma showed orderly 60s (30.7%), 50s (17.7%), 40s (17.7%) similar to adenocarcinoma. The sites of the mucinous carcinoma were 22 (35.5%) in the rectum, 21 (33.9%) in the right colon, 6 (9.7%) in the transverse colon, whereas for adenocarcinoma 250 (37.0%) in the rectum, 137 (20.3%) in the sigmoid colon, 114 (16.9%) in the ascending colon. The stage of primary tumor at diagnosis was as follows: In mucinous carcinoma, 5stage B1 (8.1%), 13 B2 (21.0%), 33 C2 (53.2%), 11 D (17.7%). In adenocarcinoma, 20 stage A (3.0%), 61 B1 (9.0%), 210 B2 (31.1%), 15 C1 (2.2%), 250 C2 (37.0%), 120 D (17.7%). Three-year and five-year disease free survival rates were similar, but slightly higher in patients with adenocarcinomas. Mean survival time was also similar, 45.5 38.1 months in the mucinous carcinoma group and 45.6 33.4 months in the adenocarcinoma. Five-year survival was 65.6% and 68.1% in patients with mucinous carcinomas and adenocarcinomas, respectively; but the difference was not statistically significant. The recurrence rates were 41.9% and 22.3% in patients with mucinous carcinoma and adenocarcinoma, respectively with statistical significance (P<0.005). Local recurrence was more frequent in the mucinous carcinoma than in the adenocarcinoma significantly.

Conclusion: Our study suggested that mucinous colorectal carcinoma showed decreased survival, although having no statistical significance and increased recurrence rates with statistical significance compared with those of adenocarcinoma. So, we recommend aggresive surgical treatment and careful follow-up in mucinous colorectal carcinoma.

키워드

결장 및 직장 점액암;생존과 재발
Mucinous colorectal carcinoma;Survival and recurrence
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