CAJ | 학술논문

目的探讨影响直肠痛根治术后局部复发患者预后因素以及术后联合辅助治疗的疗效.方法搜集2000年4月至2004年4月间105例局部复发性直肠癌再次治疗患者的病例资料和随访结果,回顾分析17项临床病理因素和患者预后的关系.确定影响局部复发性直肠癌预后的独立因素并对复发后不同治疗方式进行评价.结果随访率为95.2%,1、3、5年总生存率分别为63%、34%、19%,中位生存时间23个月.手术+放化疗(34例),单纯手术(35例)和放化疗(36例)的1、3、5年生存率分别为79%、55%、32%,68%、40%、14%和64%、36%、11%(χ~2=7.96,P=0.019).单因素分析结果表明原发肿瘤组织学分级、浸润深度、转移淋巴结数、首次术后分期、复发部位、复发时间及复发后治疗方式与预后相关;其中首次术后TNM分期、复发部位、复发时间和复发后治疗方法是影响根治术后局部复发直肠癌患者预后的独立因素.手术联合放化疗的5年生存率明显优于单纯手术及单纯辅助治疗.结论首次术后TNM分期、复发部位、复发时间和复发后治疗方式是局部复发性直肠癌的独立预后因素,手术联合放化疗可能会给局部复发性直肠癌患者带来长期生存机会.
목적 탐토영향직장통근치술후국부복발환자예후인소이급술후연합보조치료적료효.방법 수집2000년4월지2004년4월간105례국부복발성직장암재차치료환자적병례자료화수방결과,회고분석17항림상병리인소화환자예후적관계.학정영향국부복발성직장암예후적독립인소병대복발후불동치료방식진행평개.결과 수방솔위95.2%,1、3、5년총생존솔분별위63%、34%、19%,중위생존시간23개월.수술+방화료(34례),단순수술(35례)화방화료(36례)적1、3、5년생존솔분별위79%、55%、32%,68%、40%、14%화64%、36%、11%(χ~2=7.96,P=0.019).단인소분석결과표명원발종류조직학분급、침윤심도、전이림파결수、수차술후분기、복발부위、복발시간급복발후치료방식여예후상관;기중수차술후TNM분기、복발부위、복발시간화복발후치료방법시영향근치술후국부복발직장암환자예후적독립인소.수술연합방화료적5년생존솔명현우우단순수술급단순보조치료.결론 수차술후TNM분기、복발부위、복발시간화복발후치료방식시국부복발성직장암적독립예후인소,수술연합방화료가능회급국부복발성직장암환자대래장기생존궤회.
Objective To investigate the prognostic factors and the clinical outcome of locally recurrent rectal cancer after radical resection. Methods From April 2000 to April 2004, 105 patients with locally recurrent rectal cancer after radical resection were re-treated in Tianjin cancer hospital. Thirty-four patients were re-treated with surgery combined with adjuvant chemoradiotherapy (group 1), 35 with surgery alone (group 2), and 36 with chemoradiotherapy (group 3). The impact of 17 clinicopathological factors and treatment modalities on the survival was analyzed. Results The follow-up rate was 95. 2%. The median survival time was 23 months. The 1-, 3-and 5-year survival rates of patients with locally recurrent rectal cancer were 63% ,34% and 19%, respectively. The 1-, 3-and 5-year survival rates were 79%, 55% and 32% in group 1 ; 68%, 40% and 14% in group 2; and 64%, 36% and 11% in group 3; respectively (χ~2 =7. 96,P =0. 019). The univariate analysis showed that the degree of differentiation, depth of tumor invasion, number of metastatic lymph nodes, initial TNM stage, recurrent location, time to recurrence, and surgery combined with adjuvant therapy were significant prognostic factors, with the last 4 being the independent prognostic factors. Conclusions Surgery combined with chemoradiotherapy may improve the survival of patients with locally recurrent rectal cancer.