癌结节对Ⅲ期结直肠癌患者预后判断的临床价值  

Prognostic significance of tumor deposits in patients with stage Ⅲ colon cancer

作　　者：祁清华[1] 王腾[1] 茆勇[1] 华东[1] Qi Qbzghua Wang Teng Mao Yong Hua Dong(Department of Oncology, The Fourth People＇s Hospital of Wuxi, Wuxi 214062, China)

机构地区：[1]无锡市第四人民医院肿瘤内科,214062

出　　处：《中华肿瘤杂志》2016年第10期784-789,共6页Chinese Journal of Oncology

基　　金：基金项目：国家自然科学基金（81372375）;江苏省自然科学基金（BK2012538）;国家自然基金青年项目（81201600）

摘　　要：目的 探讨癌结节对Ⅲ期结直肠癌根治术后患者预后判断的临床价值。 方法 回顾性分析206例Ⅲ期结直肠癌根治术后患者的临床病理资料，采用Kaplan－Meier法和Cox多因素回归模型分析癌结节对患者无病生存时间（DFS）和总生存时间（OS）的影响。 结果 206例Ⅲ期结直肠癌患者中，无癌结节组94例（45.6%），癌结节组112例（54.4%）；无癌结节组和癌结节组患者中，年龄〈50岁者分别占10.6%和21.4%，病理低分化者分别占22.3%和36.6%，神经侵犯者分别占16.0%和29.5%，差异均有统计学意义（均P〈0.05）；且随着癌结节个数的增加，神经侵犯更多见；多因素分析显示，癌结节与Ⅲ期结直肠癌患者的DFS和OS均无关（均P〉0.05）。在N1期患者中，癌结节组和无癌结节组患者的3年无病生存率分别为23.0%和58.8%，中位DFS分别为26和43个月（P＝0.002）。无癌结节的N1a～1b期和N1c期患者的3年无病生存率分别为63.5%和21.2%，中位DFS分别为41个月和25个月（P＝0.004）。 结论 癌结节为影响N1期结直肠癌患者DFS的独立不良预后因素，癌结节个数可能是影响Ⅲ期结直肠癌患者预后的重要因素，根治术后结直肠癌患者中癌结节与神经侵犯有关，癌结节可作为N1期结直肠癌患者预后不良的评价指标。Objective To investigate the prognostic significance of tumor deposits （TD） in patients with stage Ⅲ colorectal cancer who underwent radical resection. Methods We retrospectively analyzed the clinicopathological data, and the impact of tumor deposits on the disease free survival （DFS） and overall survival （OS） in 206 patients with stage m eolorectal cancer using Kaplan-Meier and Cox regression analyses. Results Among the 206 patients with stage Ⅲ coloreetal cancer, there were 112 （54.4%） tumor deposit-positive （ TD＋ ） cases and 94 （45.6%） tumor deposit-negative （ TD ） cases. The TD- and TD＋ eases accounted for 10.6% and 21.4% of patients aged 〈50 years, 22.3% and 36.6% of patients with poorly differentiated carcinoma, and 16% and 29.5% of patients with neural invasion, respectively （P〈0.05 for all）. In addition, the neural invasion was more often found along with the inereasing number of TD. However, multivariate analysis showed that TD was not significantly associated with DFS and OS of the patients. Among the patients with N1 stage cancer, the 3-year DFS rates of TD＋ and TD- groups were 23.0% and 58.8%, and the median disease-free survival durations were 26 months and 43 months, respectively （P = 0.002）. Meanwhile, in the TD group, the 3-year DFS rates in the patients with stage N1a- 1b without tumor deposit and Nlc cancer were 63.5% and 21.2%, and the median disease-free survival durations were 41 and 25 months, respectively （P= 0.004）. Conclusions Tumor deposit is an independent unfavorable prognostic factor affecting the DFS. The number of tumor deposits may be an important 1actor affecting prognosis in stage Ⅲ colorectal cancer patients. Tumor deposits after radical resection are associated with neural invasion, and can be used as an independent factor of poor prognostic evaluation in patients with stage NI colorectal cancer.

关 键 词：结直肠肿瘤 肿瘤分期 预后:癌结节 

分 类 号：R735.34[医药卫生—肿瘤]