左半结肠癌与右半结肠癌临床病理特征及预后的比较  

Comparison of clinicopathological features and prognosis between left-sided colon cancer and right-sided colon cancer

作　　者：高显华[1] 于冠宇 刘鹏[1] 郝立强[1] 刘连杰[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：《中华胃肠外科杂志》2017年第6期647-653,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金（81201936、81572332、81572358）

摘　　要：目的 比较左半结肠癌（LC）和右半结肠癌（RC）的临床病理特征和长期预后的差异。方法 2000年1月至2010年12月，上海第二军医大学附属长海医院行手术治疗结肠腺癌患者2 174例，排除横结肠癌、部位重叠、部位不明、复发癌、多原发癌、伴发其他恶性肿瘤、术前化疗、局部切除、临床数据不完善和失访者，最终纳入1 036例行原发灶根治性切除患者的临床病理资料进行回顾性研究。将其中563例盲肠癌、升结肠癌和结肠肝曲癌患者纳入RC组，473例结肠脾曲癌、降结肠癌和乙状结肠癌患者纳入LC组。比较两组患者的临床病理特征和预后，预后包括中位总生存期、5年总生存率以及肿瘤特异性中位总生存期（是指从手术日期开始至由于肿瘤进展导致患者死亡的时间）和肿瘤特异性5年总生存率（是指从手术日期开始到术后5年内，未死于肿瘤进展的患者占病例总数的比率），多因素Cox回归分析预后的影响因素。继之采用＂倾向评分匹配＂的方法平衡两组的临床病理因素，SAS 9.3软件进行倾向评分匹配，将年龄、性别、大体类型、肿瘤直径、浸润深度、淋巴结转移、远处转移、TNM分期、分化程度、癌胚抗原（CEA）和糖类抗原（CA）19-9纳入倾向评分，然后按照评分的分值对两组进行匹配，再比较两组患者的临床病理特征和预后的差异。结果 两组患者的年龄、肿瘤远处转移率和CEA水平的差异无统计学意义（P 〉 0.05）。与RC组相比，LC组男性[60.9%（343/563）比51.0%（241/473），P= 0.001]、溃疡型肿瘤[71.9%（405/563）比65.3%（309/473），P= 0.006]、高和中分化肿瘤[87.5%（493/563）比73.8%（349/473），P= 0.000]、T1~2期肿瘤[17.1%（96/563）比10.1%（48/473），P= 0.001]、TNM分期Ⅰ期肿瘤[13.3%（75/563）比7.8%（37/473），P= 0.000]、肿瘤直径〈 5.0 cm[55.1%（310/563）比38.3%（181/473），P= 0.000]以Objective To compare the clinicopathological features and prognosis between left-sided colon cancer （LC） and right-sided colon cancer （RC） .Methods Clinicopathological and follow-up data of 2 174 colon carcinoma cases undergoing resection at Shanghai Changhai Hospital of The Second Military Medical University from January 2000 to December 2010 were retrospectively analyzed. Patients with transverse colon cancer, overlapping position, unknown location, recurrent cancer, multiple primary cancer, concomitant malignant tumors, preoperative chemotherapy, local resection, incomplete clinical data and missed follow up were excluded. Finally, a total of 1 036 patients, whose primary tumors were radically removed, were enrolled, with 563 patients in LC group （including carcinoma in cecum, ascending colon and hepatic flexure） and 473 in RC group （including carcinoma in splenic flexure, descending colon and sigmoid colon） . The clinicopathological features and survival, including median overall survival, 5-year overall survival rate, tumor specific median overall survival, cancer specific 5-year overall survival rate, were compared between LC and RC groups. Tumor specific overall survival was defined as the period between operation date to the date of death caused by cancer progression. Multivariate Cox regression analysis was used to analyze the influencing factors of survival. Propensity score matching was carried out to balance the clinicopathological factors between the two groups with the SAS 9.3, taking the following parameters into consideration （age, gender, gross appearance, tumor diameter, invasion depth, lymph node metastasis, distant metastasis, TNM stages, differentiation, CEA and CA199-9） . Patients in RC group and LC group were matched according to the propensity scores and the clinicopathological characteristics and prognosis of two groups were compared again.Results No significant differences were identified between the two groups in age, distant metastasis and serum CEA level. Compared

关 键 词：结肠肿瘤 肿瘤位置 总生存时间 预后 倾向评分匹配 

分 类 号：R735.35[医药卫生—肿瘤]