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作 者:陈瑛罡[1] 刘彦龙[1] 刘正[1] 葛欣[1] 王锡山[1]
机构地区:[1]哈尔滨医科大学附属第三医院结直肠外科,150081
出 处:《中华胃肠外科杂志》2011年第4期267-270,共4页Chinese Journal of Gastrointestinal Surgery
摘 要:目的 探讨原发ⅡC期结直肠癌炎性浸润与癌性浸润患者的预后差异及目前临床病理分期的合理性.方法 回顾分析287例原发ⅡC期结直肠癌(结肠癌152例,直肠癌135例)、120例原发ⅡB期结直肠癌(结、直肠癌各60例)及140例ⅢA期无局部浸润结直肠癌患者(结肠癌80例,直肠癌60例)的临床病理资料及随访结果.结果 152例ⅡC期结肠癌患者中癌性浸润组和炎性浸润组患者5年生存率分别为38.5%和59.4%,135例ⅡC期直肠癌患者中癌性浸润组和炎性浸润组患者5年生存率分别为42.1%和62.7%,差异均有统计学意义(均P<0.001).ⅡB期结肠癌和直肠癌患者的5年生存率与ⅡC期炎性浸润患者比较,差异均无统计学意义(均P>0.05);ⅢA期无局部浸润结肠癌和直肠癌患者的5年生存率则分别低于ⅡC期结肠癌和直肠癌癌性浸润患者(均P<0.05).原发ⅡC期结肠癌患者的预后与肿瘤分化程度、有无癌性浸润及术后并发症有关;原发ⅡC期直肠癌患者的预后与肿瘤病理类型、分化程度及有无癌性浸润有关(均P<0.05).结论 原发ⅡC期伴癌性浸润结直肠癌患者预后明显劣于ⅡC期炎性浸润者,其临床病理分期有待重新界定:局部有无癌性浸润可作为原发ⅡC期结直肠癌患者的一个独立预后因素.Objective To evaluate the differences in oncologic outcomes between inflammatory adhesion and malignant adhesion in patients with stage Ⅱ C colorectal cancer after multivisceral resection(MVR). Methods A retrospective review was undertaken of 287 patients who underwent MVR for stage Ⅱ C CRC, 120 patients for stage Ⅱ B, and 140 patients for Ⅲ A. Patients were divided into two groups: inflammatory adhesion(IA) and malignant invasion(MI). Results There were 153 patients with colon cancer and 135 patients with rectal cancer in the stage Ⅱ C group. The overall survival was significantly lower in the MI group at 5 years (38.5% vs. 59.4%, P<0.05). Stage ⅡC patients with IA had similar survival rate to the patients with stage Ⅱ B CRC. Compared to the MA group,patients with stage Ⅲ A CRC showed significant differences in 5 years overall survival rate. Univariate analysis showed that differentiation, adhesion pattern, and complication were significant prognostic factors for patients with colon cancer, while pathological characteristics, adhesion pattern, and differentiation were significant for rectal cancer. Conclusions MI is an adverse prognostic factor for patients with stage Ⅱ C CRC. T4 should be further classified according to the adhesion pattern.
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