肿瘤大小分类对0～Ⅲ期结直肠癌预后的影响  

Correlation of tumor size classification with TNM classification and prognosis of colorectal cancer

作　　者：童国俊[1] 严强[2] 张贵阳[1] 刘剑[1] 郑照正[1] 陈燕[1] 祁飞 余胜[2] 徐旭婷[3] 钮萍萍 

机构地区：[1]湖州市中心医院肛肠科,313000 [2]湖州市中心医院普外科,313000 [3]湖州市中心医院中心实验室,313000

出　　处：《浙江医学》2017年第19期1664-1666,1734,共4页Zhejiang Medical Journal

基　　金：浙江省科技计划项目(2017C33189)

摘　　要：目的探讨肿瘤大小分类对0~Ⅲ期结直肠癌(CRC)预后的影响。方法选择538例0~Ⅲ期CRC患者进行研究,术后随访5年。对术后大体标本肿瘤按3种大小分类方法(a:≤1、>1~≤3、>3~≤5、>5;b:≤2、>2~≤5、>5;c:≤2、>2~≤4、>4;单位:cm)进行分类,根据美国癌症协会第6版TNM分期(合并亚分期)进行0~Ⅲ分期。分析以上3种分类方法与TNM分期的关系,并就3种分类方法对5年总生存率(OS)作单因素和多因素分析,以探讨哪种分类方法更有优越性。结果 3种肿瘤大小分类方法与TNM分期均相关,差异均有统计学意义(均P<0.01);且分类方法 a、b、c与TNM分期均呈正相关(rs=0.436、0.379和0.415,均P<0.01)。采用log-rank检验对肿瘤大小分类与5年OS作单因素分析,发现差异均有统计学意义(均P<0.01);进一步作Cox比例风险回归模型分析,结果显示肿瘤大小分类方法 a的风险系数及95%CI为0.401(0.025~6.412),差异有统计学意义(P<0.05);肿瘤大小分类方法 b、c的风险系数及95%CI分别为4.586(0.523~40.181)、1.121(0.816~1.541),差异均无统计学意义(均P>0.05)。结论 3种肿瘤大小分类方法均与TNM分期、预后相关,其中分类方法 a是影响预后的独立因素,对预后的意义优于其他2种分类方法。Objective To investigate the correlation of tumor size classifications with TNM classification and prognosis of colorectal cancer.Methods Clinical data 538 patients with colorectal cancer,who were surgically treated from January 2006 to January2010 and followed for 5 years,were retrospectively reviewed.The tumor grades were classified by three tumor size classifications：classification A（≤1,〉1~≤3,〉3~≤5,〉5）,classification B（≤2,〉2~≤5,〉5）,classification C（≤2,〉2~≤4,〉4）.The correlation of three tumor size classifications with TNM 6th combined sub-staging was analyzed with CROSS TAB and exact χ~2 test.Kaplan-Meier method was used for survival analysis,the multivariate COX regression was applied to analyze the independent factors for prognosis.Results Three tumor size classifications were positively correlated with TNM stages（rs=0.436,0.379 and 0.415,all P〈0.01）.There were significant differences in 5-year overall survival rate among different grades in all three classifications（all P〈0.01）.Multivariate Cox regression showed that the risk coefficients of three classifications were（0.401,95%CI：0.025-6.412,P=0.006）,（4.586,95%CI：0.523-40.181,P=0.169） and（1.121,95%CI：0.816-1.541,P=0.48）.Conclusion Three tumor size classifications are correlated to TNM stage and prognosis of colorectal cancer,while only classification A is an independent determinant factor for prognosis of patient.

关 键 词：结直肠癌 TNM分期 预后 

分 类 号：R735.34[医药卫生—肿瘤]