新的解剖分型对直肠癌术后骶前复发根治性切除的影响  

Correlation between pelvic relapses of rectal cancer after radical and R0 resection:A regression model-based analysis

作　　者：郭鹏[1] 陶亮 王畅 吕昊润 杨毅[4] 胡浩[5] 李广学[6] 刘凡[3] 李育玺 叶颖江[3] 王杉[3] Guo Peng;Tao Liang;Wang Chang;Lyu Haorun;Yang Yi;Hu Hao;Li Guangxue;Liu Fan;Li Yuxi;Ye Yingjiang;Wang Shan(Department of Emergency General Surgery,Peking University People's Hospital,Beijing 100044,China;Department of Gastrointestinal Surgery,Anshun People's Hospital,Anshun 561000,China;Department of Gastrointestinal Surgery,Peking University People's Hospital,Beijing 100044,China;Department of Osteo-Oncology,Peking University People's Hospital,Beijing 100044,China;Department of Urology,Peking University People's Hospital,Beijing 100044,China;Department of Plastic Surgery,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院急诊外科,北京100044 [2]安顺市人民医院胃肠外科,安顺561000 [3]北京大学人民医院胃肠外科,北京100044 [4]北京大学人民医院骨肿瘤科,北京100044 [5]北京大学人民医院泌尿外科,北京100044 [6]北京大学人民医院整形美容科,北京100044

出　　处：《中华胃肠外科杂志》2023年第3期277-282,共6页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的本文试提出一种新的直肠癌术后骶前复发分型,并探讨该分型对再次手术根治性的影响。方法本研究为回顾性观察性研究,回顾性收集2008年1月至2022年9月期间,在北京大学人民医院胃肠外科行手术治疗的51例直肠癌骶前复发患者的临床病理资料。纳入标准:(1)原发直肠癌不伴远处转移,且接受根治性切除手术;(2)确诊为直肠癌骶前复发:根据CT、MRI、正电子发射型计算机断层显像(PET/CT)检查,体格检查或可能的手术探查和病理学组织活检,经多学科协作团队评估证实为直肠癌骶前复发;(3)住院、门诊病例资料及随访资料完整。排除直肠癌骶前复发同时伴发远处转移者。根据术后病理将患者分为根治性切除组(29例)与非根治性切除组(22例)。本研究的观察指标包括:(1)本团队根据病灶解剖特点对直肠癌骶前复发进行分型:Ⅰ型:未累及骶骨;Ⅱ型:累及低位骶骨,但尚未累及其他部位;Ⅲ型:累及高位骶骨,但尚未累及其他部位;Ⅳ型:累及骶骨及其他部位。(2)骶前复发手术治疗情况、术后至发现复发的总体生存期(OS)、无病生存期时长(DFS)。(3)影响直肠癌骶前复发的手术根治性切除因素分析。非正态分布的计量资料用M(范围)表示,组间比较采用Mann-Whitney U检验。结果全组患者中位随访25(2~96)个月,随访率100%。与直肠癌骶前复发非根治性切除组比较,根治性切除组远期转移率明显更低[24.1%(7/29)比54.5%(12/22),χ^(2)=8.333,P=0.026]、术后DFS更长[32.7(3.0~63.0)个月比16.1(1.0~41.0)个月,Z=8.907,P=0.005];术后OS虽然更长,但差异无统计学意义[39.2(3.0~66.0)个月比28.1(1.0~52.0)个月,Z=1.042,P=0.354]。单因素分析结果显示:原发肿瘤pN分期、骶前复发解剖分型、骶前复发术式与根治性切除率有关(均P<0.05),而年龄、性别、肿瘤距肛缘距离、原发肿瘤pT分期以及原发肿瘤G分期与直肠癌患者骶前复发根治性切除�Objective To propose a new staging system for presacral recurrence of rectal cancer and explore the factors influencing radical resection of such recurrences based on this staging system.Methods In this retrospective observational study,clinical data of 51 patients with presacral recurrence of rectal cancer who had undergone surgical treatment in the Department of Gastrointestinal Surgery,Peking University People's Hospital between January 2008 and September 2022 were collected.Inclusion criteria were as follows:(1)primary rectal cancer without distant metastasis that had been radically resected;(2)pre-sacral recurrence of rectal cancer confirmed by multi-disciplinary team assessment based on CT,MRI,positron emission tomography,physical examination,surgical exploration,and pathological examination of biopsy tissue in some cases;and(3)complete inpatient,outpatient and follow-up data.The patients were allocated to radical resection and non-radical resection groups according to postoperative pathological findings.The study included:(1)classification of pre-sacral recurrence of rectal cancer according to its anatomical characteristics as follows:Type I:no involvement of the sacrum;Type II:involvement of the low sacrum,but no other sites;Type III:involvement of the high sacrum,but no other sites;and Type IV:involvement of the sacrum and other sites.(2)Assessment of postoperative presacral recurrence,overall survival from surgery to recurrence,and duration of disease-free survival.(3)Analysis of factors affecting radical resection of pre-sacral recurrence of rectal cancer.Non-normally distributed measures are expressed as median(range).The Mann-Whitney U test was used for comparison between groups.Results The median follow-up was 25(2–96)months with a 100%follow-up rate.The rate of metachronic distant metastasis was significantly lower in the radical resection than in the non-radical resection group(24.1%[7/29]vs.54.5%[12/22],χ^(2)=8.333,P=0.026).Postoperative disease-free survival was longer in the radical resectio

关 键 词：直肠肿瘤 骶前复发 分型 根治性切除 回归分析 

分 类 号：R735.37[医药卫生—肿瘤]