中国普外基础与临床杂志

中国普外基础与临床杂志

术前联合评估直肠上段癌与手术方案选择的随机对照试验

查看全文

目的 探讨多学科协作(multi-disciplinary team,MDT)模式下64排多层螺旋CT(MSCT)和血清淀粉样蛋白A(serum amyloid A protein,SAA)联合术前评估直肠上段癌的临床价值和对手术方案选择的影响。
方法 前瞻性纳入2007年8月至2008年10月期间在四川大学华西医院肛肠外科住院的直肠上段癌患者110例(肿瘤下缘距齿状线gt;7 cm),随机均分为MSCT+SAA组(术前行MSCT和SAA联合评估)和MSCT组(术前只行MSCT评估),分析手术方案选择与临床病理因素的关系,并将术前分期和预测手术方案分别与术后病理分期和实际手术方案比较。
结果 本研究实际纳入病例106例,MSCT+SAA组52例,MSCT组54例,2组基线情况一致。分析直肠上段癌手术方案的选择与多种临床病理因素的关系,发现术前N分期(P=0.003)、术前M分期(P=0.022)、术前TNM分期(P=0.003)、术前血清SAA水平(P=0.005)及肿瘤大体类型(P=0.027)在不同手术方案间的差异有统计学意义。MSCT+SAA组术前T、N、M和TNM分期的准确度分别为84.6%、86.5%、100%和86.5% ; MSCT组的术前T、N、M和TNM分期的准确度分别为83.3%、62.9%、100%和64.8%。2组术前N分期和TNM分期准确度差异有统计学意义(P值分别为0.005和0.009)。2组手术方案的预测符合率分别为96.2%及81.5%,差异有统计学意义(P=0.017)。
结论 MSCT和SAA联合评估直肠上段癌患者的策略可以提高术前分期的准确性,提高肛肠外科医师预测手术方案的符合率。

Objective To determine the influence of combinative assessment of 64 multi-slice spiral computer tomography (MSCT) and serum amyloid A protein (SAA) on the selection of operative procedures of upper rectal cancer in multi-disciplinary team.
Methods Prospectively enrolled 110 patients, who were diagnosed definitely as upper rectal cancer (distance of tumor to the dentate line gt;7 cm) at West China Hospital of Sichuan University from August 2007 to October 2008, randomly assigned into two groups. In one group named MSCT+SAA group, both MSCT and SAA combinative assessment were made for the preoperative evaluation. In another group named MSCT group, only MSCT was made preoperatively. Then, the pooled data were analyzed for the correlative relationship between the choice of surgery strategy and clinicopathologic factors. Furthermore, the preoperative staging and predicted operative procedures were compared with postoperative pathologic staging and practical operative procedures, respectively.
Results According to the criteria, 106 patients with upper rectal cancer were randomly assigned into MSCT+SAA group (n=52) and MSCT group (n=54). The baseline characteristics of two groups were statistically identical. When analyzing the proportion of multiple clinicopathologic factors in different operative procedures of upper rectal cancer, there were statistical differences in the preoperative N staging (P=0.003), M staging (P=0.022), TNM staging (P=0.003), serum level of SAA (P=0.005) and general category of tumor (P=0.027). For MSCT+SAA group the accuracies of preoperative staging T, N, M and TNM were 84.6%, 86.5%, 100% and 86.5%, respectively; For MSCT group the corresponding rates were 83.3%, 2.9%, 100% and 64.8%, respectively. There were statistically significant differences accuracies of preoperative N staging and TNM staging (P=0.005, P=0.009, respectively) in two groups. There was a statistically significant difference of the accuracy of prediction to operative procedures in two groups (96.2% vs. 81.5%, P=0.017).
Conclusion Combinative assessment of 64 MSCT and SAA could improve the accuracy of preoperative staging, and thus provide higher predictive coincidence rate to operative procedures for surgeon.

关键词: 直肠肿瘤; 外科手术; 多层螺旋计算机体层摄影术; 手术前评估; 血清淀粉样蛋白A; 多学科协作

Key words: Rectal neoplasm; Surgical operation; Multi-slice spiral computer tomography; Preoperative assessment; Serum amyloid protein A; Multi-disciplinary team

引用本文: 汪晓东,宋欢,吕东昊,秦昌龙,吴俊华,李臻辉,李立. 术前联合评估直肠上段癌与手术方案选择的随机对照试验. 中国普外基础与临床杂志, 2009, 16(4): 322-326. doi: 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
1. Moss AA, Thoeni RF, Schnyder P, et al. Value of computed tomography in the detection and staging of recurrent rectal carcinomas [J]. J Comput Assist Tomogr, 1981; 5(6): 870-874.
2. GlojnaricI, Casl MT, Simic D, et al. Serum amyloid A protein (SAA) in colorectal carcinoma [J]. Clin Chem Lab Med, 2001; 39(2): 129-133.
3. Greene FL, Page DL, Fleming ID, et al Eds. AJCC cancer staging manual [M]. 6th ed. New York (NY): Springer Verlag, 2002: 113-124.
4. 李立. 结直肠癌外科应用技术的规范与创新(一) [J]. 中国普外基础与临床杂志, 2006; 13(1): 106-109.
5. 李立. 结直肠癌外科应用技术的规范与创新(二) [J]. 中国普外基础与临床杂志, 2006; 13(2): 222-226.
6. 蔡三军. 直肠癌的外科治疗进展 [J]. 中国癌症杂志, 2004; 14(5): 41-45.
7. Gollub MJ, Schwartz LH, Akhurst T. Update on colorectal cancer imaging [J]. Radiol Clin North Am, 2007; 45(1): 85-118.
8. Bipat S, Glas AS, Slors FJ, et al. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging—a meta-analysis [J]. Radiology, 2004; 232(3): 773-783.
9. Coussens LM, Werb Z. Inflammation and cancer [J]. Nature, 2002; 420(6917): 860-867.
10. Gutfeld O, Prus D, Ackerman Z, et al. Expression of serum amyloid A, in normal, dysplastic, and neoplastic human colonic mucosa: implication for a role in colonic tumorigenesis [J]. J Histochem Cytochem, 2006; 54(1): 63-73.
11. Malle E, De Beer FC. Human serum amyloid A (SAA) protein: a prominent acute-phase reactant for clinical practice [J]. Eur J Clin Invest, 1996; 26(6): 427-435.
12. Renckens R, Roelofs JJ, Knapp S, et al. The acute-phase response and serum amyloid A inhibit the inflammatory response to Acinetobacter baumannii Pneumonia [J]. J Infect Dis, 2006; 193(2): 187-195.
13. Kokubun M, Imafuku Y, Okada M, et al. Serum amyloid A (SAA) concentration varies among rheumatoid arthritis patients estimated by SAA/CRP ratio [J]. Clin Chim Acta, 2005; 360(1-2): 97-102.
14. Tolson J, Bogumil R, Brunst E, et al. Serum protein profiling by SELDI mass spectrometry: detection of multiple variants of serum amyloid alpha in renal cancer patients [J]. Lab Invest, 2004; 84(7): 845-856.
15. Weinstein PS, Skinner M, Sipe JD, et al. Acute-phase proteins or tumour markers: the role of SAA, SAP, CRP and CEA as indicators of metastasis in a broad spectrum of neoplastic diseases [J]. Scand J Immunol, 1984; 19(3): 193-208.
16. Khan N, Cromer CJ, Campa M, et al. Clinical utility of serum amyloid A and macrophage migration inhibitory factor as serum biomarkers for the detection of nonsmall cell lung carcinoma [J]. Cancer, 2004; 101(2): 379-384.
17. Cho WC, Yip TT, Yip C, et al. Identification of serum amyloid a protein as a potentially useful biomarker to monitor relapse of nasopharyngeal cancer by serum proteomic profiling [J]. Clin Cancer Res, 2004; 10(1 Pt 1): 43-52.
18. Biran H, Friedman N, Neumann L, et al. Serum amyloid A (SAA) variations in patients with cancer: correlation with disease activity, stage, primary site, and prognosis [J]. J Clin Pathol, 1986; 39(7): 794-797.
19. Le L, Chi K, Tyldesley S, et al. Identification of serum amyloid A as a biomarker to distinguish prostate cancer patients with bone lesions [J]. Clin Chem, 2005; 51(4): 695-707.
20. Yokoi K, Shih LC, Kobayashi R, et al. Serum amyloid A as a tumor marker in sera of nude mice with orthotopic human pancreatic cancer and in plasma of patients with pancreatic cancer [J]. Int J Oncol, 2005; 27(5): 1361-1369.
21. Michaeli A, Finci-Yeheskel Z, Dishon S, et al. Serum amyloid A enhances plasminogen activation: implication for a role in colon cancer [J]. Biochem Biophys Res Commun, 2008; 368(2): 368-373.
22. Miwata H, Yamada T, Okada M, et al. Serum amyloid A protein in acute viral infections [J]. Arch Dis Child, 1993; 68(2): 210-214.
23. d’Eril GM, Anesi A, Maggiore M, et al. Biological variation of serum amyloid A in healthy subjects [J]. Clin Chem, 2001; 47(8): 1498-1499.
24. 刘展, 汪晓东, 李立. 在结直肠癌领域引入多学科协作管理模式的现状 [J]. 中国普外基础与临床杂志, 2007; 14(1): 114-116.
25. 汪晓东, 李立. 结直肠肿瘤多学科协作诊治模式下整体构建理念及基本组织构架 [J]. 中国普外基础与临床杂志, 2007; 14(3): 339-342.