肿瘤部位对根治性切除术后不同分期结直肠癌患者预后的影响  

Impact of primary tumor site on the prognosis in different stage colorectal cancer patients after radical resection

作　　者：韩晶[1] 张雪[1] 张安度[2] 周欣亮[1] 冯莉[1] 王俊艳[1] 王贵英[3] 

机构地区：[1]河北医科大学第四医院肿瘤内科,石家庄050011 [2]河北医科大学第四医院放疗科,石家庄050011 [3]河北医科大学第四医院外二科,石家庄050011

出　　处：《中华外科杂志》2018年第1期68-73,共6页Chinese Journal of Surgery

摘　　要：目的探讨肿瘤部位对行根治性切除术后不同分期结直肠癌患者预后的影响。方法回顾性分析2008年1月至2015年3月2 097例于河北医科大学第四医院行结直肠癌根治性切除术患者的临床资料，其中左半结肠癌421例，右半结肠癌386例，直肠癌1 290例。分析左右半结肠癌及直肠癌患者的临床病理学特征和5年生存率差异；对不同分期的结直肠癌患者按照肿瘤部位进行分层，分析肿瘤部位对不同分期患者预后的影响。组间比较采用χ2检验、Kruskal-Wallis秩和检验，生存分析采用Kaplan-Meier曲线和Log-rank检验。结果肿瘤位于不同部位患者性别构成存在差异（左半结肠癌、右半结肠癌、直肠癌男性比例分别为62.5%、54.9%、56.3%，χ2＝6.040，P＝0.049）。与左半结肠癌、右半结肠癌相比，直肠癌患者中-高腺癌患者更多（89.7%、86.0%、82.4%，χ2为10.712、17.385，P值为0.013、0.001）、Ⅰ期患者比例更高（17.1%、6.9%、6.5%，χ2为37.459、37.208，P值为0.000、0.000）；T4（44.7%、76.7%、78.5%，χ2为128.015、133.704，P值为0.000、0.000）、远处转移（2.6%、5.7%、3.6%，χ2为1 417.167、1 424.217，P值为0.000、0.000）及肠梗阻（11.3%、21.1%、24.4%，χ2为25.846、41.141，P值为0.000、0.000）患者较少。左半结肠癌、右半结肠癌、直肠癌5年生存率差异有统计学意义（59.8%、58.9%、70.9%，χ2＝11.577，P＝0.003）。根治性切除术后的Ⅲ期结直肠癌患者肿瘤位于不同部位总体生存存在差异（χ2＝9.878，P＝0.007），而Ⅰ、Ⅱ、Ⅳ期结直肠癌患者肿瘤位于不同部位总体生存无明显差异（χ2分别为4.167、0.238、2.699，P分别为0.124、0.888、0.263）。结论肿瘤位于不同部位结直肠癌临床病理特征不同。直肠癌患者5年生存率明显优于左半结肠癌及右半结肠癌患者。对于根治性切除术后不同分期结直肠癌患者，肿瘤部位对预后的影响不同。ObjectiveTo analyze the effect to the prognosis of tumor site on the patients of colorectal cancer after curative resection with different stage.MethodsClinicopathological and follow-up data of 2 097 colorectal carcinoma cases undergoing resection at Fourth Hospital of Hebei Medical University from January 2008 to March 2015 were retrospectively analyzed. There were 421 patients in left-sided colorectal cancer （LCC） group （including carcinoma in cecum, ascending colon , hepatic flexure, and transvers colon） , 386 in right-sided colorectal cancer （RCC） group （including carcinoma in splenic flexure, descending colon and sigmoid colon） and 1 290 in rectal cancer （RECC） group. Clinicopathologic features in patients with different tumor location were compared. 5-year overall survival rate were compared among the 3 groups. Patients were stratified by different stage to analyze the effect of tumor location on the prognosis. χ2test and Kruskal-Wallis rank-sum test were used to compare the clinicopathological features among the 3 groups, Kaplan-Meier curve and Log-rank test were used to analyze prognosis, respectively.ResultsNo significant differences were identified between the three groups in age, family history, N stage and intestinal obstruction. Significant difference were found in gender among LCC, RCC and RECC group （male were 62.5% vs. 54.9% vs.56.3%, χ2=6.040, P=0.049） . Compared with LCC group and RCC group, RECC group had more well and moderately differentiated adenocarcinoma patients （89.7% vs. 86.0% vs. 82.4%, χ2=10.712 and 17.385, P=0.013 and 0.001） , more stage Ⅰ patients （17.1% vs. 6.9% vs. 6.5%, χ2=37.459 and 37.208, P=0.000 and 0.000） , and less likely to be stage T4 （44.7% vs. 76.7% vs.78.5%, χ2=128.015 and 133.704, P=0.000 and 0.000）, metastasis （2.6% vs. 5.7% vs. 3.6%, χ2=1 417.167 and 1 424.217, P=0.000 and 0.000） and intestinal obstruction （11.3% vs. 21.1% vs. 24.4%, χ2=25.846 and 41.141, P=0.000 and 0.000）. Five-year survival rate reduced in turn

关 键 词：结肠肿瘤 直肠肿瘤 预后 

分 类 号：R735.34[医药卫生—肿瘤]