肿瘤部位及临床病理特征对不同TNM分期行结直肠癌根治性切除术患者预后的影响研究  

Associations of Primary Tumor Site and Clinicopathologic Features with TNM-related Survival in Patients with Radical Resection of Colorectal Cancer

作　　者：韩晶[1] 王贵英[2] 张难[3] 张雪[1] 张安度[4] 周欣亮[1] 冯莉[1] 王俊艳[1] HAN Jing;WANG Guiying;ZHANG Nan;ZHANG Xue;ZHANG Andu;ZHOU Xinliang;FENG Li;WANG Junyan(Department of Medical Oncology,Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China;No.2 Department of Gastrointestinal Surgery,Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China;Department of Thoracic Surgery,Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China;Department of Radiotherapy,Fourth Hospital of Hebei Medical University(East Campus),Shijiazhuang 050011,China)

机构地区：[1]河北医科大学第四医院肿瘤内科,河北省石家庄市050011 [2]河北医科大学第四医院外二科,河北省石家庄市050011 [3]河北医科大学第四医院胸外科,河北省石家庄市050011 [4]河北医科大学第四医院东院放疗科,河北省石家庄市050011

出　　处：《中国全科医学》2020年第18期2275-2283,共9页Chinese General Practice

摘　　要：背景近年来越来越多的临床研究证实,晚期结直肠癌的肿瘤部位、临床病理特征影响患者的预后及靶向药物的治疗疗效。但是对于已行结直肠癌根治性切除术的患者,不同肿瘤部位是否对其预后产生不同影响,尚未有明确定论。目的探讨不同TNM分期行结直肠癌根治性切除术患者预后的影响因素,并重点分析肿瘤部位及临床病理特征对不同TNM分期结直肠癌患者预后的影响。方法选取2008年1月—2015年3月河北医科大学第四医院收治的符合研究标准的行结直肠癌根治性切除术的结直肠癌患者2097例。按照发病部位以脾区为界分为左半结直肠癌组(n=1711)及右半结直肠癌组(n=386)。回顾性收集患者的临床病理特征,包括性别、年龄、病理类型、家族史及术前肠梗阻、TNM分期、T分期、N分期、M分期、脉管瘤栓情况。采用电话、门诊随访、定期复查方式随访患者生存情况,截至2016-01-31。比较左半结直肠癌组与右半结直肠癌组患者临床病理特征;采用Cox比例风险回归分析探究结直肠癌根治性切除术后患者死亡的影响因素;采用Kaplan-Meier法绘制不同肿瘤部位结直肠癌患者的生存曲线,比较不同TNM分期患者总生存期(OS)(其中Ⅱ~Ⅲ期患者细分为结直肠癌根治性切除术后是否接受辅助化疗);记录并比较随访满5年的左半结直肠癌组与右半结直肠癌组患者生存时间≥5年的发生情况。结果左半结直肠癌组与右半结直肠癌组患者病理类型、术前肠梗阻、TNM分期、T分期情况比较,差异有统计学意义(P<0.05)。多因素Cox比例风险回归分析结果显示,病理类型、家族史、术前肠梗阻、N分期、M分期是结直肠癌根治性切除术后患者死亡的独立影响因素(P<0.05)。Ⅰ期结直肠癌患者中,左半结直肠癌患者OS优于右半结直肠癌患者(χ^2=3.843,P=0.049)。Ⅱ期结直肠癌患者中,左、右半结直肠癌患者OS比较,差�Background An increasing number of studies have confirmed that tumor site and clinicopathological characteristics are associated with the effectiveness of targeted therapy and survival in advanced colorectal cancer patients.But there is no final conclusion on whether tumor site is associated with the survival in those with radical resection.Objective To investigate the factors(with focus on tumor site and clinicopathological characteristics)associated with TNM-related survival in patients with radical resection of colorectal cancer.Methods This retrospective study was conducted in 2097 eligible patients with radical resection of colorectal cancer from Fourth Hospital of Hebei Medical University from January 2008 to March 2015.Clinicopathological characteristics were collected,including gender,age,pathological type,family history of colorectal cancer,preoperative intestinal obstruction,TNM stage,T stage,N stage,M stage,blood vessel invasion and were compared in those with left-sided colorectal cancer(LSCC)(n=1711)and right-sided colorectal cancer(RSCC)(n=386),namely,by the side that colorectal cancer originates from splenic flexure.Survival status was followed up by telephone,outpatient follow-up and regular review as of January 31,2016.Cox proportional hazards regression analysis was used to investigate the influencing factors of death.Kaplan-Meier method was used to plot the survival curve.The overall survival(OS)was analyzed by TNM stage,specifically involving the influence of adjuvant chemotherapy in those with stageⅡ-Ⅲ.Also,the rate of surviving at least 5 years after resection in those with a 5-year follow-up was compared by tumor site.Results LSCC and RSCC patients showed significant differences in the distribution of pathological type,TNM stage and T stage,and prevalence of preoperative intestinal obstruction(P<0.05).Multivariate Cox proportional hazards regression analysis showed that pathological type,family history of colorectal cancer,preoperative intestinal obstruction,N stage,and M stage were ind

关 键 词：结直肠肿瘤 左半结直肠癌 右半结直肠癌 预后 结肠切除术 肿瘤分期 疾病特征 

分 类 号：R735.34[医药卫生—肿瘤]