癌结节对根治性手术后Ⅲ期结肠癌患者预后的影响  

Tumor deposit is an independent prognostic factor in patients with stageⅢcolon cancer after radical surgery

作　　者：崔艳成[1] 周宇石 申占龙[1] 尹慕军[1] 杨晓东[1] 姜可伟[1] 叶颖江[1] 梁斌[1] Cui Yancheng;Zhou Yushi;Shen Zhanlong;Yin Mujun;Yang Xiaodong;Jiang Kewei;Ye Yingjiang;Liang Bin(Department of Gastrointestinal Surgery,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院胃肠外科,北京100044

出　　处：《中华普通外科杂志》2022年第4期260-264,共5页Chinese Journal of General Surgery

基　　金：北京大学人民医院研究与发展基金资助项目(RDY2020-18);北京大学临床医学+X青年专项基金(BMU2021MX009)。

摘　　要：目的探讨癌结节对根治手术后Ⅲ期结肠癌患者预后的影响。方法回顾性分析2015年1至12月在北京大学人民医院胃肠外科接受根治性手术的155例Ⅲ期结肠癌患者的临床病理资料,分析癌结节与肿瘤位置、分期、分化程度、错配修复状态、脉管癌栓、术前血清CEA和CA19-9水平之间的关系,研究癌结节对患者术后生存的影响。结果155例Ⅲ期结肠癌患者中37例(23.9%)合并有癌结节,脉管内癌栓、术前血清CA19-9升高的患者癌结节的发生率更高(χ^(2)=9.567,P=0.002;χ^(2)=11.561,P=0.003);癌结节患者较无癌结节患者总生存率和无疾病生存率均低(总生存率:P=0.029;无疾病生存率:P=0.025)。多因素COX分析发现合并癌结节是影响患者术后总生存率和无病生存率的独立危险因素(HR=1.990,95%CI:1.032~3.835,P=0.040;HR=2.416,95%CI:1.205~3.820,P=0.009)。结论癌结节是影响Ⅲ期结肠癌患者术后预后的独立危险因素。对于存在淋巴结转移的结肠癌患者,将癌结节纳入TNM分期可以更准确地反映患者预后。Objective To explore the effect of tumor deposit(TD)on the prognosis of patients with stageⅢcolon cancer after radical resection.Methods The clinicopathological data of patients with stageⅢcolon cancer after radical surgery at the Department of Gastrointestinal Surgery,Peking University People's Hospital from Jan to Dec 2015 were analyzed collected.Clinicopathological characteristics such as tumor location,degree of differentiation,mismatch repair status,lymphatic and venous invasion,and preoperative CEA and CA19-9 levels were used to study the effect of TD on the postoperative survival of patients.Results Among the 155 patients with stageⅢcolon cancer,37(23.9%)had tumor deposits.The incidence of tumor deposits was higher in patients with intravascular tumor thrombus and preoperative serum CA19-9 elevation(χ^(2)=9.567,P=0.002;χ^(2)=11.561,P=0.003);Patients with tumor deposits had worse overall survival and disease-free survival than those without cancer nodules(OS:P=0.029,DFS:P=0.025).Multivariate COX analysis found that tumor deposit was an independent risk factor for postoperative overall survival and disease-free survival(HR=1.990,95%CI:1.032-3.835,P=0.040;HR=2.416,95%CI:1.205-3.820,P=0.009).Conclusions Tumor deposit is an independent risk factor affecting postoperative overall survival and disease-free survival in patients with stageⅢcolon cancer.For patients with lymph node metastasis,incorporating TD into TNM staging can more accurately predict the postoperative prognosis.

关 键 词：结肠肿瘤 淋巴转移 预后 癌结节 

分 类 号：R735.35[医药卫生—肿瘤]