不同治疗模式对结直肠癌患者预后影响的回顾性分析  

Effect of hospital based therapies on the prognosis of colorectal cancer: A retrospective analysis of 813 patients

作　　者：崔莲[1,2] 刘容锐[1] 陈玉玲[1] 刘建芝[1] 刘烈军[1] 张允[1] 贾茹[1] 赵传华[1] 葛飞娇[1] 林莉[1] 王岩[1] 徐建明[1] 

机构地区：[1]军事医学科学院附属三〇七医院消化肿瘤科,北京100071 [2]解放军第三〇五医院干部病房,北京100017

出　　处：《中国肿瘤临床与康复》2016年第9期1030-1035,共6页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的探讨国内结直肠癌的临床治疗现状和对预后的影响。方法回顾性分析2006年1月至2012年7月间军事医学科学院附属医院收治的813例结直肠癌患者的临床资料,初诊无转移者499例,其中接受根治性手术484例,根据患者既往接受治疗的医院分为A级(省级和省级以上医院)和B级(地市级和地市级以下医院)。比较不同级别医院、不同治疗模式对结直肠癌患者预后的影响。结果 A级医院患者手术后中位无病生存期(DFS)和中位总生存期(OS)显著优于B级医院(P=0.01,P=0.05)。A级医院高危Ⅱ期和Ⅲ期患者接受辅助化疗比例显著高于B级医院(P=0.01)。A级医院患者辅助化疗的中位DFS和中位OS较B级医院明显延长(P<0.05,P=0.04)。254例接受根治手术的直肠癌患者中,有99例接受了围手术期放疗,Ⅰ期、Ⅱ期和Ⅲ期患者接受围手术期放疗比例分别为30.8%、25.5%和47.4%。338例术后复发转移的患者中,原发灶位于左半结肠患者的中位OS优于右半结肠者(P=0.05)。266例Ⅳ期患者中,接受根治性原发灶和转移灶切除手术患者的预后明显优于原发灶姑息性切除联合解救化疗、单纯解救化疗、仅接受局部治疗和未接受任何治疗的患者,差异有统计学意义(P=0.00)。结论不同级别医院在根治性手术和辅助化疗中存在较大差异,直接影响患者的预后。Ⅳ期患者应把握根治性原发灶和转移灶的切除机会,以获得长期生存。Objective To analyze the effect of various therapies provided by different hospitals on the prognosis of 813 colorectal cancer patients. Methods The clinical data of 813 colorectal cancer patients in The Affiliated Hospital of the Chinese Academy of Military Medical Science from January 2006 to December 2012 were retrospectively analyzed. Four hundred and ninety nine patients had no metastasis in the initial diagnosis,in which 484 patients received radical surgery. According to the levels of hospitals where the patients were treated,therapies for colorectal cancer were classified into provincial and higher-level hospitals（ level A） and local and lower-level hospitals（ level B）. The effect of therapies provided by different levels of hospitals on the prognosis of colorectal cancer was compared. Results The median disease free survival（ DFS） and overall survival（ OS） in level A hospitals were obviously longer than level B hospitals（ P = 0. 01,P = 0. 05）. Significantly higher ratio of patients at stage II and III high risk in level A hospitals can obtain adjuvant chemotherapy than level B hospitals（ P = 0. 01）. The median DFS and OS were obviously longer in the patients who received adjuvant chemotherapy in level A hospitals than level B hospitals（ P〈0. 05,P = 0. 04）. Among the 254 patients who received radical surgery,99 patients received perioperative radiotherapy,with 30. 8 % at stage I,25. 5 % at stage II and 47. 4 % at stage III. Among 338 patients with relapsed and / or metastatic disease after receiving radical surgery,median OS in patients whose primary tumor was located in the left colon was better than in patients located in the right colon（ P = 0. 05）. Among 266 patients at stage IV,prognosis of patients who received radical excision of both primary and metastasis tumors was significantly better than that of patients who received palliative resection of the primary tumor combined with chemotherapy,palliative chemotherapy alone,only local therapy or without any treatment�

关 键 词：结直肠肿瘤 治疗模式 预后 

分 类 号：R735.34[医药卫生—肿瘤]