原发性阑尾腺癌的临床病理特征和预后分析  

Clinicopathological features and prognosis of primary appendiceal adenoearcinoma

作　　者：梁建伟[1] 王征[1] 周志祥[1] 张兴茂[1] 胡俊杰[1] 赵平[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院腹部外科,100021

出　　处：《中华肿瘤杂志》2012年第8期616-619,共4页Chinese Journal of Oncology

摘　　要：目的探讨原发性阑尾腺癌的临床病理特征和预后因素。方法回顾性分析1994年3月至2009年10月收治的、随访资料完整的42例原发性阑尾腺癌患者的临床病理资料，采用Kaplan-Meier法进行生存分析，预后因素的单因素分析采用Logrank检验，多因素分析采用Cox回归模型。结果42例患者中，黏液型腺癌26例（61．9％），结肠型腺癌12例（28．6％），印戒细胞癌4例（9．5％）。全组中18例患者行根治性切除术，20例患者行减瘤术，4例患者仅行探查活检术。术后30例患者接受以5一氟尿嘧啶为基础的辅助化疗。除术后8d因肺动脉栓塞死亡1例外，另41例患者的1、3、5年生存率分别为80．3％、46．0％和38．3％。单因素分析显示，是否以急性阑尾炎起病、手术方式、病理类型、是否辅助化疗、术前癌胚抗原（CEA）水平、分化程度和临床分期是影响患者预后的因素（P〈0．05）。多因素分析显示，术前CEA水平、分化程度和临床分期是影响患者预后的独立因素。结论原发性阑尾腺癌术前CEA水平升高、中低分化和晚期的患者预后差。Objective To explore the clinicopathological characteristics and prognostic factors of primary appendiceal adenocarcinoma. Methods The clinicopathological data of 42 patients with primary appendiceal ad treated in the Cancer Hospital of Chinese Academy of Medical Sciences between March 1994 and October 2009 were retrospectively analyzed. The survival analysis was conducted using Kaplan-Meier method. The factors influencing survival were analyzed using univariate （Log-rank） and multivariate （Cox） models. Results A total of 42 patients （29 female and 13 males, median age 56 years） with appendiceal adenocarcinoma were included in this study. Of them, 26 （ 61. 9% ） were mucinous adenocarcinoma, 12 （28.6%） were intestinal-type adenocarcinoma and 4 （9.5%） were signet cell carcinoma. 18 patients underwent curative resection, 20 patients received cytoreductive surgery, and 4 patients underwent biopsy only. Thirty patients received systemic chemotherapy （5-Fu-based regimens）. One patient who died of postoperative pulmonary embolism on day 8 was excluded from the survival analysis. The overall 1-, 3-, and 5-year survival rate was 80.3% , 46.0% and 38.3% , respectively. Univariate analysis revealed that presence of symptoms of acute appendicitis, curative resection, histological grade, histological subtype, preoperative CEA level, systematic chemotherapy, and stage were all significant factors affecting the survival. Multivariate analysis showed that the preoperative CEA level （ P = 0.01 ） , histological grade （P =0.001） , and stage （P =0.001） were independent prognostic factors. Conclusions High level of CEA, G2/3 grade, and advanced stage are associated with poor prognosis in patients with primary appendiceal adenocarcinoma.

关 键 词：阑尾肿瘤 病理学 诊断 外科手术 生存率 预后 

分 类 号：R735.36[医药卫生—肿瘤]