Ⅱ/Ⅲ期结直肠癌术后早期胸腹盆CT随访的临床意义  

The clinical value of early CT scan after radical surgery for stage Ⅱ/Ⅲ colorectal cancers

作　　者：闫俊平 刘国臣 黄基伟[1] 曹东林[1] YAN Junping;LIU Guochen;HUANG Jiwei;and CAO Donglin(Department of Laboratory Medicine,Guangdong Second Provincial General Hospital,Guangzhou 510317,China;Department of Gynecology,Guangdong Cancer Center,Yat-Sen University,Guangzhou 510060,China)

机构地区：[1]广东省第二人民医院检验医学部,广州510317 [2]广东省中山大学肿瘤防治中心妇科,广州510060

出　　处：《中华灾害救援医学》2018年第6期318-323,共6页Chinese Journal of Disaster Medicine

基　　金：2013年度广东省级财政技术研究开发与推广应用专项资金项目(粤财工﹝2013﹞401号)

摘　　要：目的探讨Ⅱ/Ⅲ期结直肠癌术后早期(6个月内)胸腹盆计算机X线断层扫描(computed tomography,CT)检查随访的临床意义。方法采用病例对照研究回顾性地收集2009-01至2012-05初诊于中山大学肿瘤防治中心并接受根治性手术的Ⅱ/Ⅲ期结直肠癌患者447例的病例资料。其中,第一次CT时间距离手术时间<6个月的记为早期CT检查组(n=150),第一次CT时间距离手术时间≥6个月的记为非早期CT检查组(n=297)。对比分析两组的转移发现率、转移灶的数目/大小、可再手术率、患者总生存率等情况。结果 (1)早期CT检查组患者术后第一次CT检查前有临床症状及癌胚抗原(carcino-embryonic antigen,CEA)异常比例高于非早期CT检查组(P<0.05)。(2)非早期CT检查组和早期CT检查组最终出现转移患者的比例差异无统计学意义(χ~2=2.043,P=0.153);但在第一次CT检查时,非早期CT检查组(13.1%)比早期CT检查组(6.7%)检出更多转移患者(χ~2=4.267,P=0.039);而按分期来看,非早期CT检查组Ⅱ期(χ~2=2.290,P=0.130)和Ⅲ期患者(χ~2=2.656,P=0.103)比例均高于早期CT检查组,但差异无统计学意义。(3)通过对第一次CT检查发现的49例远处转移灶秩和分析发现:早期CT检查组转移灶长径和(Z=-2.642,P=0.008)小于非早期CT检查组,但是二者转移灶数目(Z=-1.117,P=0.264)与最长径(Z=-1.938,P=0.053)差异无统计学意义。(4)非早期CT检查组和早期CT检查组总的可再手术率差异无统计学意义(χ~2=0.122,P=0.727);Ⅲ期患者中,非早期CT检查组和早期CT检查组的可补救手术率差异无统计学意义(χ~2=0.044,P=0.853)。(5)非早期CT检查组4年总生存率高于早期CT检查组,但两者差异无统计学意义(χ~2=2.032,P=0.150)。结论术后有症状或者CEA升高可能是促使患者接受早期CT检查的原因。早期CT随访虽然可发现体积更小的转移,但是不能发现更多可再手术的转移,也不能带来生存的获益。Objective The objective of this study was to evaluate the clinical value of early（within six months after surgery） computed tomography（CT） for stage Ⅱ/Ⅲ colorectal cancer. Methods A case-control study was conducted to review the data of 447 cases of stage Ⅱ/Ⅲ colorectal cancer patients who underwent radical surgery in Cancer Center of Yat-Sen University from January 2009 to May 2012. Among them, patients who underwent the first CT within six months after surgery were selected as early CT group（n=150）,while patients who underwent the first CT after six months were selected as non-early CT group（n=297）. The metastatic rate, number/size of metastases, reoperation rate, and patient overall survival rate were compared between the two groups. Results（1） The abnormal proportion of the clinical symptoms and carcino-embryonic antigen（CEA） before the first CT examination in the early CT group was higher than that in the non-early CT group（P〈0.05）.（2） There was no significant difference in the metastatic rate between the two groups（χ~2=2.043, P=0.153）. However, the number of metastatic patients in non-early CT group（13.1%） was bigger than that in the early CT group（6.7%） in the first CT examination（χ~2=4.267, P=0.039）. In terms of the stage, the detection rate of metastatic of stageⅡ（χ~2=2.290, P=0.130） and stageⅢ（χ~2=2.656, P=0.103） in the non-early CT group was higher than that in the early CT group, but the difference was not statistically significant.（3） By rank sum test, the sum of longest diameters（Z=-2.642, P=0.008） of metastasis lesions in the early CT group were smaller than those in nonearly CT group, but there was no significant difference in the longest diameter（Z=-1.938, P=0.053） and the number of metastatic lesions（Z=-1.117, P=0.264） between the two groups.（4） There was no significant difference in the rate of reoperation between the two groups（χ~2=0.122, P=0.727）, so was that in stage Ⅲ patients（χ~2=0.044,

关 键 词：结直肠癌 计算机X线断层扫描 随访 

分 类 号：R735[医药卫生—肿瘤]