原发结直肠癌超系膜切除术后患者的生存危险因素分析  

Prognostic factors analysis for long-term survival after radical surgery for primary rectal cancer with beyond mesorectal excision

作　　者：张金珠 梅世文 孙金峰[2] 胡刚 邱文龙 李国利[2] 汪欣[3] 王锡山 汤坚强 Zhang Jinzhu;Mei Shiwen;Sun Jinfeng;Hu Gang;Qiu Wenlong;Li Guoli;Wang Xin;Wang Xishan;Tang Jianqiang(Department of Colorectal Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Anorectal Surgery,Chifeng Municipal Hospital,Chifeng 024000,China;Department of General Surgery,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院结直肠外科,北京100021 [2]内蒙古赤峰市医院肛肠外科,024000 [3]北京大学第一医院普通外科,北京100034

出　　处：《中华结直肠疾病电子杂志》2024年第3期197-204,共8页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：吴阶平医学基金会临床科研专项资助基金课题(320.6750.2021-04-2);北京市自然科学基金(4232058)。

摘　　要：目的探讨影响超系膜切除层面原发结直肠癌患者术后长期生存的危险因素.方法回顾分析了2010年1月至2021年12月于中国医学科学院肿瘤医院、北京大学第一医院及赤峰市医院接受根治性手术治疗的局部晚期原发结直肠癌患者的临床资料.通过Cox多因素回归分析,对影响其总生存时间(OS)及无进展生存时间(DFS)的危险因素进行分析.结果共纳入符合入组和排除标准的局部晚期原发结直肠癌患者共557例,全组患者1年、3年、5年OS分别为90.9%、74.7%、63.2%;1年、3年、5年DFS分别为83.7%、66.9%、62.2%.Cox回归分析最终确定年龄>60岁(OS:HR=1.980,P<0.001;DFS:HR=1.429,P=0.019)、术前放化疗(OS:HR=1.639,P=0.005;DFS:HR=1.845,P<0.001)、癌性侵犯(OS:HR=1.418,P=0.028;DFS:HR=1.690,P=0.001)、淋巴结转移(OS:HR=1.773,P<0.001;DFS:HR=2.347,P<0.001)及非R0切除(OS:HfR=2.138,P=0.004;DFS:HR=2.944,P<0.001)为影响患者OS及DFS的独立危险因素(P<0.05).结论年龄大于60岁、术前放化疗、癌性侵犯、淋巴结转移及切缘阳性与局部晚期原发结直肠癌患者较差的预后相关.Objective To explore the risk factors affecting the long-term survival of patients with primary colorectal cancer undergoing beyond mesorectal excision.Methods A retrospective analysis was performed on clinical data of patients with locally advanced primary colorectal cancer who underwent radical surgery between January 2010 and December 2021 at Cancer Hospital of Chinese Academy of Medical Sciences,Peking University First Hospital,and Chifeng Municipal Hospital in China.Cox multivariate regression analysis was used to analyze the risk factors that affect their overall survival time and progression-free survival time.Results A total of 557 patients with locally advanced primary colorectal cancer who met the inclusion and exclusion criteria were included.The overall survival rates at 1 year,3 years,and 5 years were 90.9%,74.7%,and 63.2%,respectively,while the disease-free survival rates at 1 year,3 years,and 5 years were 83.7%,66.9%,and 62.2%,respectively.Cox regression analysis identified age>60(OS:HR=1.980,P<0.001;DFS:HR=1.429,P=0.019),neoadjuvant chemoradiotherapy(OS:HR=1.639,P=0.005;DFS:HR=1.845,P<0.001),cancer invasion(OS:HR=1.418,P=0.028;DFS:HR=1.690,P=0.001),lymph node metastasis(OS:HR=1.773,P<0.001;DFS:HR=2.347,P<0.001),and non-R0 resection(OS:HR=2.138,P=0.004;DFS:HR=2.944,P<0.001)as independent risk factors affecting overall survival and disease-free survival of patients(P<0.05).Conclusion Age over 60,neoadjuvant chemotherapy,cancer invasion,lymph node metastasis and non-R0 resection are associated with poor prognosis in patients with locally advanced colorectal cancer.

关 键 词：结直肠肿瘤 局部晚期结直肠癌 无复发生存期 总生存期 

分 类 号：R735.37[医药卫生—肿瘤]