A total of 506 distal colorectal cancer patients were classified into two groups, to clarify the variables affecting survival of the patients with macroscopic invasion into the adjacent organs: 47 cases showed invasion (invasive group) while the other did not show invasion (noninvasive group). Differences between the invasive and noninvasive groups were found in eight variables; female, large tumor size, gross types 3 and 4, moderately or poorly differentiated adenocarcinomas and signet-ring cell or mucinous carcinomas, deep cancer invasion, lymphatic invasion, peritoneal and liver metastases, and curability B-C were found significantly more frequently in the invasive group. The survival curve of the former was significantly (P < 0.05) lower than that of the latter. However, no significant difference was found between the survival curves of the patients with curability A (no residual tumors) in both groups. A multivariate analysis in the invasive groups revealed six variables to be significantly related to a good prognosis including a young age, females, a location above the peritoneal reflection, well differentiated adenocarcinoma, negative lymphatic invasion, and curability A. Surgery with curability A should be performed to improve the survival in distal colorectal cancer patients with macroscopic invasion into the adjacent organs.
The correlations of nm23-H1 expression in primary cancer lesions with the already confirmed 14 prognostic variables and survival were examined in 52 advanced colorectal cancer patients, because the clinical roles of nm23-H1 expression in the cancer lesions remain controversial. An immunohistochemical expression of nm23-H1 was found in 23 lesions (positive group) but not found in 29 lesions (negative group). No significant difference between the positive and negative groups was found according to 12 clinicopathological variables including vascular invasion, lymph node and liver metastases, and histological stage. The carcinoembryonic antigen levels (21.5+/-33.4 ng/ml) of the draining venous blood and argyrophilic nucleolar organizer regions score (3.35+/-1.36 per nucleus) of the cancer cells in the positive group were not significantly diffeent from those (34.1+/-102.9 ng/ml and 3.32+/-1.00 per nucleus, respectively) in the negative group. In addition, no significant difference was found in the survival curves or the 5-year survival rates of the positive and negative groups. From these results, it may be concluded that the nm23-H1 expression was not associated with the aforementioned prognostic variables and the prognosis of advanced colorectal cancer patients.
Correlations between carcinoembryonic antigen (CEA) levels of peripheral (p) and draining (d) venous blood and postoperative hematogenous metastases (HM) were examined in 76 advanced (T2-4) colorectal adenocarcinoma patients, to clarify a predictive value of dCEA and the gradient (d-pCEA) between d- and pCEA levels in patients with HM. HM were found in 19 patients (HM group), but not found in 57 patients (non-HM group). The mean value (27.4 ng/ml) of dCEA and positive rates (100 and 89.5%) of d- and d-pCEA levels were significantly higher than those (9.8 ng/ml and 57.9%) of pCEA in the HM group, though no significant difference was found among p-, d-, and d-pCEA values and positive rates in the non-HM group. Significant linear correlations, Y (log dCEA, ng/ml) = -0.039X (month) + 2.016 and Y (log d-pCEA, ng/ml) = -0.039X (month) + 1.823, were found between d- and d-pCEA levels and HM-diagnostic period. These results suggest that colorectal cancer patients with HM are more effectively predicted by the determination of d- and d-pCEA levels than of pCEA levels and that they are patients with positive d- and d-pCEA levels. These patients seem to have a high possibility of early HM.
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