直肠癌骶前复发临床病理特征及预后分析  

Clinicopathological features and prognosis in patients with presacral recurrent rectal cancer

作　　者：王畅 郭鹏[1] 杨晓东[1] 谢启伟[1] 尹慕军[1] 姜可伟[1] 梁斌[1] 申占龙[1] 沈凯[1] 王杉[1] 叶颖江[1] Wang Chang;Guo Peng;Yang Xinodong;Xie Qiuei;Yin Mujun;Jiang Kewei;Liang Bin;Shen Zhanlong;Shen Kai;Wang Shan;Ye Yingjiang(Department of Gastrointestinal Surgery,Laboratory of Surgical Oncology,Pehing Unirersily People's Hospial,Beijing 100044,China)

机构地区：[1]北京大学人民医院胃肠外科,北京大学人民医院外科肿瘤实验室,北京市结直肠癌诊疗研究重点实验室,100044

出　　处：《中华胃肠外科杂志》2020年第5期461-465,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金(81871962)。

摘　　要：目的:探讨直肠癌骶前复发的临床病理学特征及预后影响因素。方法:直肠癌骶前复发的诊断为直肠癌根治性手术后,肿瘤复发向后累及骶前软组织和(或)侵犯骶尾骨或骶神经根;根据临床症状(盆腔、背部或下肢疼痛;便血、排粪次数增多和异常分泌物)、体检会阴或盆腔肿块,结合影像检查结果和结肠镜病理组织学活检结果,经多学科协作团队(MDT)评估证实。本研究采用回顾性病例对照研究方法。病例纳入标准:(1)原发直肠癌不伴远处转移,且接受直肠癌根治手术者;(2)诊断为直肠癌骶前复发;(3)住院及门诊病例资料及随访资料完整。根据上述标准,回顾性收集北京大学人民医院2008年1月至2017年12月期间收治的72例直肠癌骶前复发患者临床资料,总结患者的临床病理特征,采用Cox比例风险模型分析直肠癌骶前复发的预后影响因素。结果:72例患者中,男性45例,女性27例,男女比1.7∶1.0,中位复发年龄58(34~83)岁,中位复发间隔时间为2.0(0.2~17.0)年。48.6%(35/72)的患者以疼痛为主要临床表现,25.0%(18/72)的患者出现消化道症状。骶前复发部位为骶前软组织36例(50.0%),低位骶骨(S3~S5)或尾骨25例(34.7%),高位骶骨(S1~S2)11例(15.3%)。采用根治性手术(经腹或经腹会阴联合切除、单纯骶骨切除及腹骶联合切除等)47例(65.3%),非根治性手术(结肠造口、减瘤手术)12例(16.7%),未接受手术治疗(姑息放化疗、营养支持治疗)13例(18.1%);33例(45.8%)接受放疗和(或)化疗(药物包括奥沙利铂、氟尿嘧啶、卡培他滨、伊立替康等)。全组患者随访率100%,中位随访时间19(2~72)个月。全组中位生存时间14(1~65)个月,1年和3年总体生存率分别为67.1%和32.0%。单因素分析结果显示,复发时年龄(P=0.031)和手术治疗情况(P<0.001)与患者骶前复发的预后有关;多因素分析结果显示,根治性切除是预后良好的独立保护因素(RR=0.140,95%CI:0.061~0.322Objective To investigate the clinicopathological features and prognostic factors in patients with presacral recurrent rectal cancer(PRRC).Methods PRRC was defined as recurrence of rectal cancer after radical surgery involving posteriorly the presacral soft tissue,the sacrum/coccyx,and/or sacral nerve root.The diagnosis is confirmed with clinical symptoms(pain of pelvis/back/lower limb,bloody stools,increased frequency of defecation,and abnormal secretions),physical examination of perineal or pelvic masses,radiological findings,colonoscopy with histopathological biopsy,and the evaluation by multi-disciplinary team(MDT).Inclusion criteria:(1)primary rectal cancer undergoing radical surgery without distant metastasis;(2)PRRC was diagnosed;(3)complete inpatient,outpatient and follow-up data.According to the above criteria,clinical data of 72 patients with PRRC in Peking University People′s Hospital from January 2008 to December 2017 were retrospectively analyzed.The clinicopathological features and follow-up data were summarized.Cox proportional hazard models was used to analyze the prognostic factors of PRRC.Results Among 72 patients,45 were male and 27 were female with a male-to-female ratio of 1.7:1.0.The median age at recurrence was 58(34 to 83)years and the median interval from surgery to recurrence was 2.0(0.2 to 17.0)years.The main symptom was pain in 48.6%(35/72)of patients.In addition,gastrointestinal symptoms were found in 25.0%(18/72)of patients.The presacral recurrent sites were presacral fascia in 36(50.0%)patients,lower sacrum(S3~S5 or coccyx)in 25(34.7%)patients,and higher sacrum(S1~S2)in 11(15.3%)patients.Forty-seven(65.3%)patients underwent radical surgery(abdominal resection,abdominoperineal resection,sacrectomy,abdominosacral resection),12(16.7%)underwent non-radical surgery(colostomy,cytoreductive surgery),and 13(18.1%)did not undergo any surgery but only receive palliative chemoradiotherapy and nutritional support treatment.Thirty-three(45.8%)patients received radiotherapy and/or chemotherapy(o

关 键 词：直肠肿瘤 骶前复发 临床病理特征 预后 

分 类 号：R735[医药卫生—肿瘤]