中国普外基础与临床杂志

中国普外基础与临床杂志

原发肿瘤部位对不同期结直肠癌根治性切除术后预后的影响分析

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目的 探讨原发肿瘤部位对不同期结直肠癌根治性切除术后患者预后的影响。 方法 回顾性选择 2008 年 1 月至 2016 年 12 月期间在笔者所在医院接受根治性切除手术治疗的结直肠癌患者 420 例,所有患者均经病理学检查确诊。 根据结直肠癌肿瘤的具体部位将患者分为直肠组(n=220)、左半结肠组(n=105)和右半结肠组(n=95)。比较不同组别患者临床病理特征方面的差异,采用单因素和多因素非条件 Cox 回归分析影响结直肠癌患者预后的危险性因素,并采用 Kaplan-Meier 法绘制生存曲线,应用 log-rank 法进行差异性检验。 结果 3 组患者在年龄、BMI、吸烟史、嗜酒史、家族史、脉管瘤栓、N 分期、肿瘤直径、神经侵犯和癌结节方面的差异均无统计学意义(P>0.05),在性别、病理学类型、术前肠梗阻、TNM 分期、T 分期和 M 分期方面的差异有统计学意义(P<0.05)。单因素 Cox 回归分析结果显示,性别、病理学类型、术前肠梗阻、TNM 分期、T 分期、M 分期、原发肿瘤部位、神经侵犯和癌结节是影响患者预后的危险性因素(P<0.05);多因素 Cox 回归分析结果显示,TNM 分期、原发肿瘤部位和神经侵犯是影响患者预后的危险性因素(P<0.05)。直肠组患者 5 年总生存率为 80.45%(177/220),左半结肠组患者 5 年总生存率为 67.62%(71/105),右半结肠组患者 5 年总生存率为 68.42%(65/95)。Kaplan-Meier 法生存曲线结果显示,3 组之间的差异有统计学意义(P<0.05)。 结论 直肠癌患者 5 年生存率显著高于左半结肠癌及右半结肠癌患者。对于根治性切除术后不同分期结直肠癌患者,原发肿瘤部位可预测结直肠癌患者的预后。

Objective To investigate the impact of primary tumor site on prognosis of colorectal cancer after radical resection in different stages. Methods Four hundreds and twenty patients with colorectal cancer in our hospital from Jan. 2008 to Dec. 2016 were selected as study subjects, all patients were confirmed by pathology. According to the location of colorectal cancer, the patients were divided into rectum group (n=220), left colon group (n=105) and right colon group (n=95). The difference of clinicopathological features of patients with different group were compared. The risk factors affecting the prognosis of colorectal cancer patients were analyzed by single factor and multi factor unconditional Cox regression analysis, and the survival curve was drawn by Kaplan-Meier method, and the difference test was carried out by log-rank method. Results There were no significant differences between the three groups in age, BMI, smoking history, alcohol history, family history, vascular tumor thrombus, N staging, tumor diameter, nerve invasion and cancer nodule (P>0.05). There were significant differences in sex, pathological type, anterior intestinal obstruction, TNM staging, T staging and M staging (P<0.05). The results of single factor Cox regression analysis showed that sex, pathological type, anterior intestinal obstruction, TNM staging, T staging, M staging, primary tumor site, nerve invasion and cancer nodule were the risk factors for the prognosis of the patients (P<0.05). Multivariate Cox regression analysis showed that TNM staging, location of primary tumor and nerve invasion were risk factors affecting prognosis of patients (P<0.05). The total 5-year survival rate of the rectal group was 80.45% (177/220), the total 5-year survival rate of the left hemicolon group was 67.62% (71/105), and the total 5-year survival rate of the right hemicolon group was 68.42% (65/95). The survival curves of Kaplan-Meier showed that the difference between the three groups was statistically significant (P<0.05). Conclusons The 5-year survival rate of patients with rectal cancer is significantly higher than that of patients with left colon cancer and right colon cancer. For patients with different stage of colorectal cancer after radical resection, the prognosis of colorectal cancer can be predicted by the location of primary tumor.

关键词: 结直肠癌; 预后; 原发肿瘤部位; 总生存率

Key words: colorectal cancer; prognosis; primary tumor site; overall survival rate

引用本文: 陆丹, 余兆惠. 原发肿瘤部位对不同期结直肠癌根治性切除术后预后的影响分析. 中国普外基础与临床杂志, 2019, 26(2): 185-191. doi: 10.7507/1007-9424.201809057 复制

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