CAJ | 학술논문

目的探讨中低位直肠癌环周切缘状态与预后的关系,并分析与临床病理特征的关系.方法采用大组织切片技术,对49例行全直肠系膜切除术的中低位直肠癌标本环周切缘状态进行检查.采用Kaplan-Meier法分析术后局部复发率、远处转移率和5年生存率与环周切缘的关系,并对临床病理特征进行单因素分析. 结果中低位直肠癌环周切缘阳性率为24%(12/49),术后局部复发率为12%(6/49),远处转移率为27%(13/49).环周切缘阳性的中低位直肠癌局部复发率为33%(4/12),明显高于环周切缘阴性的5%(2/37)(X2=6.577,P=0.010);环周切缘阳性的远处转移率为50%(6/12),切缘阴性者为19%(7/37)(X2=4.491,P=0.034);环周切缘阳性的5年生存率为33%,明显低于环周切缘阴性的78%,Kaplan-Meier生存分析显示,环周切缘与生存时间密切相关(log-rank,P=0.009).环周切缘状态与肿瘤直径(X2=4.451,P=0.035)、T分期(X2=20.283,P=0.000)、N分期(X2=7.773,P=0.018)、肿瘤距齿状线距离(X2=6.502,P=0.04)、肿瘤位置(X2=4.421,P=0.035)及手术方式(X2=5.754,P=0.016)有关.结论环周切缘状态是影响中低位直肠癌预后的重要因素,中低位直肠癌环周切缘状态与肿瘤直径、T分期、N分期、肿瘤距齿状线距离、肿瘤位置及手术方式存在相关.
목적 탐토중저위직장암배주절연상태여예후적관계,병분석여림상병리특정적관계.방법 채용대조직절편기술,대49례행전직장계막절제술적중저위직장암표본배주절연상태진행검사.채용Kaplan-Meier법분석술후국부복발솔、원처전이솔화5년생존솔여배주절연적관계,병대림상병리특정진행단인소분석. 결과 중저위직장암배주절연양성솔위24%(12/49),술후국부복발솔위12%(6/49),원처전이솔위27%(13/49).배주절연양성적중저위직장암국부복발솔위33%(4/12),명현고우배주절연음성적5%(2/37)(X2=6.577,P=0.010);배주절연양성적원처전이솔위50%(6/12),절연음성자위19%(7/37)(X2=4.491,P=0.034);배주절연양성적5년생존솔위33%,명현저우배주절연음성적78%,Kaplan-Meier생존분석현시,배주절연여생존시간밀절상관(log-rank,P=0.009).배주절연상태여종류직경(X2=4.451,P=0.035)、T분기(X2=20.283,P=0.000)、N분기(X2=7.773,P=0.018)、종류거치상선거리(X2=6.502,P=0.04)、종류위치(X2=4.421,P=0.035)급수술방식(X2=5.754,P=0.016)유관.결론 배주절연상태시영향중저위직장암예후적중요인소,중저위직장암배주절연상태여종류직경、T분기、N분기、종류거치상선거리、종류위치급수술방식존재상관.
Objective To study the relationship between circumferential resection margin status and prognosis of patients with middle and lower rectal cancer.Methods Specimens from 49 patients with middle and lower rectal cancer undergoing total mesorectal excision were studied by the large slice pathologic technique.The local recurrence,metastasis and five-year survival rate were evaluated by Kaplan-Meier Survival analysis.The related clinicopathologic factors were also analyzed.Results The cancer involvement rate of the circumferential resection margins was 24%(12/49).The overall local recurrence rate was 12%(6/49),the distant metastasis and recurrence rate was 27%(13/49),and the five-year survival rate was 67%(33/49).For the 12 patients in which the eircumferential resection margin was tumor positive.the local recurrence rate was 33%compared with 5%in those with negative circumferential resection margin(X2=6.577,P=0.010),distant recurrence was 50%compared with 19%in those with tumor negative margin(X2=4.491,P=0.034).Kaplan-Meier survival analysis showed that patient's survival time was statistically correlative with the circumferential resection margin status(log-rank.P=0.009).Five-year survival rate was 33%in patients with positive circumferential resection margin,compared with 78%in those with negative margins.Tumor diameter(X2=4.451,P=0.035),T staging (X2=20.283,P=0.000),N staging(X2=7.773,P=0.018),the distance away from the anocutaneous line(X2=6.502,P=0.04),tumor location(X2=4.421,P=0.035)and operation type(X2=5.754,P=0.016)were significantly correlated with the circumferential resection margin status of the middle and lower rectal cancer.Conclusions The circumferential resection margin status was an important predictor of local and distant recurrence as well as survival of patients with middle and lower rectal carcinoma.and the status is significantly correlated with tumor diameter,T staging,N staging,the distance away from the anocutaneous line,tumor location and operation type.