直肠癌患者术后生存与复发的临床病理因素探讨  

Clinical and pathologic prognostic factors affecting local recurrence and overall survival in 1 166 rectal cancer resection patients

作　　者：刘启志[1] 楼征[1] 高显华[1] 孟荣贵[1] 傅传刚[1] 于恩达[1] 郝立强[1] 王汉涛[1] 王颢[1] 张卫[1] 

机构地区：[1]第二军医大学附属长海医院肛肠外科,上海200433

出　　处：《中华普通外科杂志》2017年第1期5-8,共4页Chinese Journal of General Surgery

基　　金：国家自然科学面上基金资助项目（81572358）;上海科委自然科学基金资助项目（16ZR1400800）

摘　　要：目的探讨直肠癌患者总体生存时间及复发转移与临床病理因素之间的相关性。方法回顾性分析第二军医大学附属长海医院2005—2010年收治的1166例直肠癌患者临床病理特征及随访资料。应用Kaplan—Meier分析临床预后，并通过COX回归分析确立影响直肠癌患者预后的独立因素。结果有1166例直肠癌患者人组，入组患者1、3、5年的总体生存率分别为94．3％、81．2％、76．5％，中位生存时间为53个月，其中328例（28．1％）发生肿瘤复发转移，中位复发时间18个月。多因素分析显示，术前CEA水平、术前CA19—9水平、肿瘤距齿状线距离、手术方式、手术根治情况、肿瘤浸润深度、病理分化程度、淋巴结转移数目和术后治疗是影响患者生存预后的独立因素；手术方式、手术根治情况、肿瘤浸润深度和淋巴结转移数目是影响患者复发的独立因素。结论影响直肠癌患者生存预后的重要因素为术前CEA和CA19．9水平、肿瘤距齿状线距离、手术方式、手术根治情况、病理分化程度、肿瘤浸润深度、淋巴结转移数目和术后治疗。Objective To explore the clinicopathologic factors impacting recurrence and survival in rectal cancer patients after radical resection. Methods Clinicopathologic data of 1 166 patients with rectal cancer in Changhai Hospital, were recruited between 2005 and 2010. Kaplan-Meier analysis and the logrank test were used to evaluate the effects of the pathology on patients＇ survival. Cox regression model was used to assess independent factors associated with clinical prognosis. Results The 1, 3, 5-year overall survival rates were 94. 3%, 81.2% and 76. 5%, median survival time was 53 months. 328 patients had recurrence and metastases, with a median recurrence time of 18 months. The independent prognostic factors for overall survival time were CEA, CA19-9, tumor distance to dentate line, surgical modality, radical operation, tumor invasion, tumor differentiation, lymph node metastasis and postoperative treatment. Surgical treatment, radical operation or not, tumor invasion and lymph node metastasis were statistically significant associated with tumor recurrence and metastases. Conclusions The important factors influencing the prognosis of rectal cancer patients were CEA, CA19-9, tumor distance to dentate line, surgical modality, radial operation, tumor in vasion, tumor differentiation, lymph node metastasis, and post operative treatment.

关 键 词：直肠肿瘤 复发 肿瘤转移 预后 

分 类 号：R735.37[医药卫生—肿瘤]