局部复发时间对直肠癌患者预后的意义及其影响因素分析  

Analysis of the significance of local recurrence time for the prognosis of rectal cancer patients and its influencing factors

作　　者：杨艳鹏 王文鹏 孔大陆 王捷夫 Yanpeng Yang;Wenpeng Wang;Dalu Kong;Jiefu Wang(Department of Colorectal Cancer,Tianjin Medical University Cancer Institute&Hospital,National Clinical Research Center for Cancer,Tianjin’s Clinical Research Center for Cancer,Tianjin Key Laboratory of Cancer Prevention and Therapy,Tianjin 300060,China)

机构地区：[1]天津医科大学肿瘤医院结直肠肿瘤科,国家恶性肿瘤临床医学研究中心,天津市恶性肿瘤临床医学研究中心,天津市肿瘤防治重点实验室,天津市300060

出　　处：《中国肿瘤临床》2024年第24期1261-1266,共6页Chinese Journal of Clinical Oncology

基　　金：国家自然科学基金面上项目(编号:82373134)资助。

摘　　要：目的:直肠癌局部复发出现的时间对患者预后有一定的影响,通过寻找准确的时间,界定直肠癌局部复发的早晚,并对其预后意义进行探究。方法:回顾性选取2006年1月至2019年12月于天津医科大学肿瘤医院收治的111例局部复发性直肠癌(locally recurrent rectal cancer,LRRC)并行手术治疗患者的临床资料。采用最小P值法及Log-rank检验确定早期复发(early recurrence,ER)及晚期复发(late recurrence,LR)的界值。ER的危险因素分析采用Logistic回归分析。复发肿瘤切除的预后因素分析采用Cox比例风险模型。结果:直肠癌早晚期局部复发时间的界定值为26个月(P<0.001)。ER患者中位无复发生存(recurrence-free survival,RFS)时间为14.1个月,复发后生存(post-recurrence survival,PRS)时间为23.7个月。LR患者中位RFS为33.4个月,PRS为35.8个月。早期及晚期局部复发直肠癌患者的5年总生存(overall survival,OS)率分别为32.5%和57.1%(P<0.001)。单因素及多因素分析结果显示,组织学分化较差、淋巴结阳性、脉管癌栓及术后未行放疗是ER的危险因素。其中术后未行放疗是ER的独立危险因素。结论:直肠癌根治性手术后26个月内复发可定义为ER,ER患者预后较差。Objective:The time to local recurrence of rectal cancer affects patient prognosis.Our study aimed to establish a clear threshold to distinguish between early and late recurrence and analyze their risk and prognostic factors.Methods:We conducted a retrospective selection and analysis of clinical data from 111 patients with locally recurrent rectal cancer(LRRC)who underwent proctectomy at Tianjin Medical University Cancer Institute&Hospital between January 2006 and December 2019.The minimum P-value approach and Log-rank test were used to determine the cut-off values of early recurrence(ER)and late recurrence(LR).Risk factors for early recurrence were analyzed using Logistic regression models,and prognostic factors associated with additional surgery were assessed using Cox proportional hazards models.Results:Based on the minimum P value approach,the optimal interval to distinguish early from late recurrence was 26 months(P<0.001).In the ER cohort,the median recurrence-free survival(RFS)was 14.1 months and post-recurrence survival(PRS)was 23.7 months.The median RFS of LR patients was 33.4 months,whereas the median PRS was 35.8 months.The 5-year survival rates in the ER and LR groups were 32.5%and 57.1%,respectively(P<0.001).In the univariate analysis,poor differentiation,positive lymph nodes,presence of lymphovascular invasion,and absence of radiotherapy enhanced the likelihood of early recurrence.Furthermore,only radiotherapy caused a significant difference in the multivariate analysis.Conclusions:Early recurrence of rectal cancer can be defined as recurrence within 26 months after radical surgery,and patients with early recurrence have a poorer prognosis.

关 键 词：局部复发性直肠癌 早期复发 晚期复发 生存分析 

分 类 号：R735.37[医药卫生—肿瘤]