CAJ | 학술논문

目的探讨中低位直肠癌系膜浸润及环周切缘状态与预后的关系.方法采用大组织切片技术,检查49例行全直肠系膜切除术的中低位直肠癌标本的直肠系膜浸润程度,判断其环周切缘状态,随访分析术后局部复发率、远处转移率和5年生存率.结果本组49例患者术后局部复发6例(12.2%),远处转移13例(26.5%);5年生存率67.3%(33/49).直肠系膜浸润程度Ⅰ、Ⅱ、Ⅲ度者分别为20例、13例、16例;局部复发分别为0、1、5例(x2=7.357、P=0.015);远处转移分别为2、3、8例(x2=7.405、P=0.025);5年生存率分别为90.O%(18/20)、69.2%(9/13)、37.5%(6/16);Kaplan-Meier生存分析显示,直肠系膜浸润程度与生存时间密切相关(P=0.013).环周切缘阳性率24.5%(12/49);环周切缘阳性的局部复发率明显高于阴性的[33.3%(4/12)比5.4%(2/37),x2=6.577、P=0.010];前者远处转移率50%(6/12)高于后者[18.9%(7/37),x2=4.491、P=0.034];环周切缘阳性的直肠癌患者5年牛存率明显低于阴性的(33.3%比78.4%);Kaplan-Meier生存分析显示,环周切缘状态与生存时间密切相关(P=0.009).结论直肠系膜浸润程度和环周切缘状态是影响中低位直肠癌预后的重要因素.
목적 탐토중저위직장암계막침윤급배주절연상태여예후적관계.방법 채용대조직절편기술,검사49례행전직장계막절제술적중저위직장암표본적직장계막침윤정도,판단기배주절연상태,수방분석술후국부복발솔、원처전이솔화5년생존솔.결과 본조49례환자술후국부복발6례(12.2%),원처전이13례(26.5%);5년생존솔67.3%(33/49).직장계막침윤정도Ⅰ、Ⅱ、Ⅲ도자분별위20례、13례、16례;국부복발분별위0、1、5례(x2=7.357、P=0.015);원처전이분별위2、3、8례(x2=7.405、P=0.025);5년생존솔분별위90.O%(18/20)、69.2%(9/13)、37.5%(6/16);Kaplan-Meier생존분석현시,직장계막침윤정도여생존시간밀절상관(P=0.013).배주절연양성솔24.5%(12/49);배주절연양성적국부복발솔명현고우음성적[33.3%(4/12)비5.4%(2/37),x2=6.577、P=0.010];전자원처전이솔50%(6/12)고우후자[18.9%(7/37),x2=4.491、P=0.034];배주절연양성적직장암환자5년우존솔명현저우음성적(33.3%비78.4%);Kaplan-Meier생존분석현시,배주절연상태여생존시간밀절상관(P=0.009).결론 직장계막침윤정도화배주절연상태시영향중저위직장암예후적중요인소.
Objective To study the relationship between tumor infiltration in mesorectum and prognosis of middle and lower rectal cancer. Methods 49 patients with middle and lower rectal cancer underwent total mesorectal excision. Specimens were obtained during operation and underwent large slice pathologic technique to observe the degree of tumor infiltration in mesorectum and circumferential resection margin. Follow-up was conducted for 61 (9 - 66) months to observe the local recurrence rate, metastasis rote, and five-year survival rate. Results Follow-up showed a local recurrence rate of 12. 2% (6/49), distant metastasis rate of 26. 5% (13/49), and five-year survival rate of 67. 3% (33/49). The rate of degree Ⅰ of tumor infiltration in mesorectum was 40. 8% (20/49), the degree Ⅱ rate was 26. 5% (13/ 49), and the degree Ⅲ rate was 32. 7% (16/49) with the corresponding local recurrence rates of 0, 7. 7% (1/13) , and 31.3% (5/16) respectively (x2 = 7. 357, P = 0. 015), metastatic rates of 10% (2/20), 23. 1% (3/13), and 50% (8/16) respectively (x2 = 7. 405, P = 0. 025), and the 5-year survival rates of 90% (18/20), 69. 2% (9/13), and 37. 5% (6/16)respectively . Kaplan-Meier survival analysis showed that the survival time was correlated with the degree of tumor infiltration in mesorectum (P = 0. 012). The rate of circumferential resection margin involvement was 24. 5% (12/49). In the 12 patients with positive circumferential resection margin, the local recurrence rate wag 33. 3% (4/12), whereas 5.4% (2/37) in those with negative circumferential resection margin (x2 = 6.577, P = 0.010). Distant metastasis rate was 50% (6/12) in the patients with positive circumferential resection margin, whereas 18. 9% (7/37) in those with negative one (x2 =4. 491 ,P =0. 034). The 5-year survival rate of the patients with positive circumferential resection margin was 33. 3% (4/12), significantly lower than that of the patients with negative circumferential resection margin [78. 4% (29/37)] . Kaplan- Meier survival analysis showed survival time was correlated with the circumferential resection margin status (P = 0. 009). Conclusion The degree of tumor infiltration in mesorectum and circumferential resection margin status are important predictors of local and distant recurrence as well as survival of patients with middle and lower rectal carcinoma. `