Title0-Ⅲ期直肠癌综合治疗856例回顾性研究
Other TitlesRetrospective analysis of 856 cases with stage 0 to Ⅲ rectal cancer underwent curative surgery combined modality therapy
Authors陈鹏举
姚云峰
赵军
李明
彭亦凡
詹天成
杜长征
王林
陈楠
Affiliation100142,北京大学肿瘤医院暨北京市肿瘤防治研究所结直肠肿瘤外科恶性肿瘤发病机制及转化研究教育部重点实验室
Keywords直肠肿瘤
放射疗法,辅助
肿瘤复发,局部
存活率分析
Rectal neoplasms
Radiotherapy,adjuvant
Neoplasm recurrence,local
Survival analysis
Issue Date2015
Publisher中华外科杂志
Citation中华外科杂志.2015,53,(7),496-501.
Abstract目的 总结单中心10年间0~Ⅲ期直肠癌综合治疗效果,分析影响预后的因素.方法 回顾性分析2001年1月至2010年12月在北京大学肿瘤医院结直肠肿瘤外科行根治性手术的856例0~Ⅲ期直肠癌患者的临床病理和随访资料.全组患者男性470例,女性385例,平均年龄(58±12)岁.Kaplan-Meier法进行总生存时间和无病生存时间分析,Log-rank检验比较各组的生存情况,Cox回归分析筛选直肠癌的独立预后因素.结果 患者术后TNM分期0期18例,Ⅰ期209例,Ⅱ期235例,Ⅲ期394例.296例术前评估为cT3或N+以上的患者接受了术前放疗,病理完全缓解率为5.4%(16/296),5年局部复发率为4.7% (14/296).所有患者总体局部复发率为4.8%,其中3年内复发占70.7%,5年内复发占97.6%.远处转移率为16.4%,3年内转移占82.9%,5年内转移占96.4%.肺转移患者影像学异常的发生率明显高于肝脏和其他部位转移(75.0%比21.7%,x2=25.691,P=0.000),CEA升高的发生率在肝转移患者中明显高于在肺转移及其他部位转移(56.8%比37.8%,x2=25.691,P =0.000).生存分析显示0、Ⅰ、ⅡA、ⅡB、ⅡC、ⅢA、ⅢB和ⅢC各期5年生存率分别为100% 、90.0%、81.3%、76%、64.8%、69.3%、59.0%和36.8%,各期间生存率差异有统计学意义(p=0.000).多因素分析结果显示,年龄(P=0.015,HR=1.385,95% CI:1.066 ~1.801)、手术方式(P=0.029,HR=1.337,95% CI:1.030~1.733)、分化程度(P=0.000,HR=1.535,95% CI:1.222~ 1.928)、TNM分期(P=0.000,HR=1.349,95% CI:1.260 ~1.444)及脉管癌栓(P=0.001,HR=1.715,95% CI:1.258~2.342)是直肠癌的独立预后因素.结论 年龄、手术方式、分化程度、脉管癌栓和TNM分期是直肠癌的独立预后因素.完善的术前评估、术前新辅助放疗、术后辅助化疗以及严密随访是直肠癌综合治疗的关键.
Objective To investigate the survival and prognostic factors of stage 0 to Ⅲll rectal cancer in 10 years.Methods Clinical data and follow-up of 856 rectal cancer patients with stage 0-Ⅲ underwent curative surgery from January 2000 to December 2010 were retrospective analyzed.There were 470 male and 386 female patients,with a mean age of (58 ± 12) years.Kaplan-Meier method was used to analyze the overall survival and disease free survival.Log-rank test was used to compare the survival between groups.Cox regression was used to analyze the independent prognostic factors of rectal cancer.Results The patients in each stage were stage 0 with 18 cases,stage Ⅰ with 209 cases,stage Ⅱ with 235 cases,and stage Ⅲ with 394 cases.All patients received curative surgery.There were 296 patients evaluated as cT3,cT4 and any T with N + received preoperative radiotherapy.5.4% patients got pathological complete response (16/296),and the recurrence rate was 4.7% (14/296).After a median time of 41.7 months (range 4.1 to 144.0 months) follow-up,the 5-year overall survival rate in stage 0 to Ⅰ of was 91.0%,stage Ⅱ] 86.2%,and stage Ⅲ 60.0%,with a significant difference (P =0.000).The cumulative local recurrence rate was 4.8% (41/856),of which 70.7% (29/41) occurred within 3 years postoperatively,97.6% (40/41) in 5 years.The cumulative distant metastasis rate was 16.4% (140/856),of which 82.9% (129/140) occurred within 3 years postoperatively,96.4% (135/140) in 5 years.The incidence of abnormal imaging findings was significantly higher in pulnonary than liver and other sites metastases (75.0% vs.21.7%,x2 =25.691,P =0.000).The incidence of CEA elevation was significantly higher in liver than lung and other sites metastases (56.8% vs.37.8%,x2 =25.691,P =0.000).Multivariable analysis showed that age (P=0.015,HR =1.385,95% CI:1.066 to 1.801),surgical approach (P =0.029,HR=1.337,95% CI:1.030 to 1.733),differentiation (P=0.000,HR =1.535,95% CI:1.222 to 1.928),TNM stage (P =0.000,HR =1.349,95% CI:1.260 to 1.444) and lymphovascular invasion (P=0.001,HR =1.715,95% CI:1.258 to 2.342) are the independent prognostic factors for rectal cancer.Conclusions Age,surgical approach,differentiation,TNM stage and lymphovascular invasion are independent prognostic factors for rectal cancer.Preoperative evaluation and combined modality therapy can significant reduce the local recurrence and improve overall survival for rectal cancer patients.
URIhttp://hdl.handle.net/20.500.11897/418131
ISSN0529-5815
DOI10.3760/cma.j.issn.0529-5815.2015.07.004
Appears in Collections:北京肿瘤医院

Files in This Work
There are no files associated with this item.

Web of Science®



Checked on Last Week

Scopus®



Checked on Current Time

百度学术™



Checked on Current Time

Google Scholar™





License: See PKU IR operational policies.