World Journal of Surgery

, Volume 26, Issue 5, pp 626–630 | Cite as

DNA index and S-phase fraction in curative resection of colorectal adenocarcinoma: Analysis of prognosis and current trends

  • Han-Shiang Chen
  • Shyr-Ming Sheen-Chen
  • Chen-Chang Lu
Original Scientific Reports

Abstract

The DNA index (DI) and S-phase fraction (SPF) have been said to be independent factors in colorectal adenocarcinoma and have a different distribution from the clinicohistologic parameters. This study assesses the real efficacy of DI and SPF for curative resection of colorectal adenocarcinomas with respect to the prognosis and the clinicohistologic parameters. From July 1991 to October 1994 a total of 666 patients underwent curative resection of colorectal adenocarcinoma and DNA flow cytometry in Kaohsiung Chang Gung Memorial Medical Center Hospital, Taiwan. We defined diploid tumors as having a DI of τ; 0.9 but<1.1 and a nondiploid tumor as having a DI of <0.9 or >1.1. A high SPF was defined as being more than the median value for the total SPF. Altogether, 495 cases (74.32%) had a 5-year cancer-free survival. Tumor stage, DI, tumor location, and tumor morphology were associated with significant cancer-free survival in the univariate analysis (p=0.0295,<0.001, 0.0357, and<0.001, respectively). After all factors were entered into the multivariate analysis, the independent factors for cancer-free survival were found to be stage, tumor location, and morphology (p<0.001, 0.012, and 0.044, respectively). In cases distinguished by the DI, diploid tumors had significantly more frequent right colon locations (p<0.001). After cases were separated by the SPF (median value 18.4%), better histology (well differentiated adenocarcinoma) was noted with a low SPF (p=0.017). No other clinicohistologic parameters had significant differences shown by the DI or SPF. Thus DI and SPF failed to appear as independent factors for 5-year cancer-free survival. The independent factors for curative colorectal adenocarcinoma were tumor stage, location, and morphology. Diploid tumors were located at the right colon more often, and low SPF indicated better histology in the univariate analysis.

Résumé

On a dit que l’indexe d’ADN (ID) et la fraction de phase-S (FPS) étaient des facteurs prédictifs indépendants du cancer colorectal dont la distribution varie selon les différents paramètres clinicohistologiques. Cette étude a comme but d’évaluer l’efficacité réelle de l’ID et de la FPS après résection à visée curatrice du cancer colorectal en ce qui concerne le pronostic et les paramètres clinicohistologiques. Entre juillet 1991 et Oct 1994, 666 cas d’adénocarcinome colorectal opérés à visée curatrice à l’hôpital du Centre Médical Kaohsiung Chang Gung Memorial à Taiwan ont eu également une cytometric de flux pour l’ADN. Nous avons défini la tumeur dipioïde comme 0.9 ID<1.1 et une tumeur non-diploïde comme ID<0.9 ou τ; 1.1. Le taux de FPS était dit élevé lorsqu’il était supérieur à la médiane de toutes les valeurs de FPS. La survie à 5 ans sans cancer a été de 495 cas (74.32%). Le stade tumoral, l’ID, le site tumoral et la morphologie tumorale étaient tous associés à une survie sans cancer significative en analyse univariée (respectivement, p=0.0295,<0.001, 0.0357, et<0.001). Après avoir introduit tous ces facteurs en analyse multivariée, les facteurs indépendants de survie sans cancer ont été le stade, le site tumoral et la morphologie (respectivement, p<0.001, 0.012, et 0.044). Dans les cas individualisés par l’ID, les tumeurs diploïdes étaient localisées plus souvent à droite (p<0.001). Selon la séparation en groupes au-dessus et en dessous de la valeur médiane limite de HPS (valeur médiane: 18.4%), on a noté une meilleure histologie (adénocarcinome bien différencié) pour les valeurs basses de FPS (p=0.017). Aucune autre différence significative dans les paramètres clinicohistologiques n’a été mise en évidence selon les critères ID ou FPS. Ni l’ID ni le FSP n’apparat comme facteur indépendant de survie à 5 ans sans cancer. Les facteurs indépendants pour résection à visée curatrice de i’adénocarcinome colorectal étaient le stade tumoral, le site et la morphologie. Les tumeurs diploïdes sont localisées plus souvent à droite et une valeur basse de la FPS est associée à une histologie plus favorable en analyse univariée.

Resumen

Se ha sostenido que el Índice de ADN (DI) y la fracción de la fase S (SPF) eran factores independientes en el adenocarcinoma colorrectal con diferente distribución por lo que a los parámetros clínico-histológicos se refiere. Este estudio investiga la eficacia real del DI y SPF, tras resección curativa del adenocarcinoma colorrectal, por lo que al pronóstico y parámetros clínico-histológicos atañe. En el hospital Kaohsiung Chang Gung Memorial Center de Taiwan, desde julio de 1991 a octubre de 1994 se efectuaron 666 resecciones curativas por adenocarcinomas colorrectales, realizándose retrospectivamente una citometría de flujo ADN. Se consideró que un tumor era diploide cuando 0.9< DI >1.1 y no-diploide cuando el DI<0.9 o DI τ; 1.1. Se consideró que la SPF estaba alta cuando la fracción SPF era mayor al valor medio de la SPF total. 495 casos (74.32%) sobrevivieron 5 años libres de enfermedad neoplásica. El estadio tumoral, el Índice de ADN (DI), la localización y morfología de la neoplasia se correlacionaron significativamente, en un análisis univariante, con la supervivencia libre de enfermedad neoplásica (p=0.0295, <0.001, 0.0357, y<0.001 respectivamente). Si todos estos parámetros se estudian mediante análisis multivariante constataremos que los factores independientes para la supervivencia libre de cáncer son: el estadio, la localización y la morfología del cáncer (p<0.001, 0.012, y 0.044). Si se diferencian los casos por el DI se constata, que los tumores diploides asientan preferentemente en el colon derecho (p<0.001). Si se estudian los casos en relación con la SPF (valor medio: 18.3%) registraremos que SPF bajos se observan en adenocarcinomas bien diferenciados (p=0.017). El estudio del DI y SPF no permite ninguna otra diferenciación clínico-histopatológica significativa. El DI y la SPF parecen no tener valor alguno como factores independientes para la supervivencia a los 5 años libres de enfermedad neoplásica. Los factores independientes por lo que a la resección curativa de los adenocarcinomas colorrectales se refiere son: el estadio, la localización y la morfología tumoral. Los tumores diploides se localizan preferentemente en colon derecho y una SPF baja indica un mejor pronóstico histológico en análisis univariantes.

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Copyright information

© the Société Internationals de Chirurgie 2002

Authors and Affiliations

  • Han-Shiang Chen
    • 1
  • Shyr-Ming Sheen-Chen
    • 1
  • Chen-Chang Lu
    • 1
  1. 1.Department of Colon and Rectal Surgery and General Surgery, Chang-Gung Memorial Hospital at Kaohsiung, College of MedicineChang-Gung UniversityNiao-Sung Hsiang, Kaohsiung HsienTaiwan, ROC

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