Local recurrence and its related mortality after potentially curative resection for rectal cancer have been analysed in a series of 1008 patients managed by one of the authors. Nine hundred and thirty-four were available for analysis of recurrence. One hundred and seven (11 per cent) patients developed local recurrence without evidence of systemic spread and 84 (9 per cent) both local and systemic recurrence. Local recurrence was less common (14 per cent) after resection of tumours of the upper third of the rectum compared with the middle (21 per cent) (P = 0.02) or lower thirds (26 per cent) (P less than 0.001). Local recurrence was related to both tumour stage and differentiation (P less than 0.001). There was no significant relationship between local recurrence and tumour size or the type of curative resection performed, restorative or non-restorative. The distal margin of clearance after restorative resection did not influence the local recurrence rate. Of patients who developed metastases recurrence was evident within 2 years in 60 per cent. Three hundred and thirty-two patients died from recurrence, 91 (27 per cent) with evidence of local recurrence only, 80 (24 per cent) with combined local and systemic recurrence and 161 (48 per cent) with evidence of systemic spread only. The corresponding median survivals were 35, 34 and 39 months.
A total of 1578 patients were treated with potentially curative surgical resection for colon and rectal cancer by one surgeon from 1950 to 1982. Follow-up revealed that 117 (11.5 percent) of 1013 patients with rectal carcinoma eventually presented with clinical evidence of pulmonary recurrence, with or without evidence of spread elsewhere; the corresponding figures for the colon were 20 (3.5 percent) of 565 (P less than 0.001). An analysis of the times to recurrence revealed that half of the lung recurrences were clinically obvious within 32 months for rectal tumors and 34 months for colonic, compared to 22 and 21 months, respectively, for liver recurrences, excluding those with other distant metastases. The slower recurrence rate and the longer survival in patients with recurrences in the lung compared to the liver were statistically significant only for rectal primaries (P less than 0.02 and P = 0.001, respectively). Sixteen patients underwent surgery with curative intention for lung recurrences; four of these remain alive at two, six, 11, and 15 years, and one patient was free of recurrence when he died from other causes 15 months after surgery. The conditional probability survival rate for the 16 patients was 38 +/- 13 percent at five years after recurrence operation.
Between 1950 and 1978 754 patients underwent operation by one of the authors for carcinoma of the colon. Follow-up data were available on 99 per cent. Tumour stage distribution did not differ significantly with increasing duration of symptoms. The proportion of curative to palliative operative procedures was unrelated to symptom duration. Cancer specific survival for the entire patient series was worse when symptoms had been present for less than 3 months compared with 3-6 months, 6-12 months or 12 months or more (P less than 0.001, P less than 0.02 and P less than 0.04, respectively). Cancer specific survival after curative resection was also worse in patients with a symptom duration of less than 3 months compared with 3-6 months or 12 months or more (P less than 0.02 and P less than 0.03, respectively). These results show that colon cancer patients in whom the diagnosis is made and operation performed after a short symptomatic period do not have less advanced tumours nor better survival prospects.
A long-term ovarian carcinoma cell line is described in terms of its morphology, original histopathology, electron microscopic features and chromosome features before and after transplantation into an athymic nude mouse. The microscopic features of the tumor nodule grown in the nude mouse are compared with the original pathology. Epithelial characteristics of the cells were maintained in culture and after retrieval from the nude mouse. Three markers were identified in all karyotypes and trisomy was noted in chromosomes 1, 2, 3, 6, 11, 12, 16, and X and monosomy of 17 and 21.
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