中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2013年
6期
431-434
,共4页
直肠肿瘤%局部复发%危险因素
直腸腫瘤%跼部複髮%危險因素
직장종류%국부복발%위험인소
Rectal neoplasms%Local recurrence%Risk factors
目的 分析影响直肠癌根治性切除术后局部复发的危险因素.方法 回顾性分析2000年1月至2009年3月中山大学附属第六医院行直肠癌根治性切除术后获得完整随访150例患者的临床资料.其中局部复发的患者(复发组)50例,按照性别相同,年龄相差≤3岁进行1∶2配对,挑选出100例直肠癌根治性切除术后未局部复发患者(未复发组)作为对照.筛选出肿瘤位置、术后化疗、肿瘤分化程度、脉管或神经浸润、T分期、肿瘤直径、获取淋巴结总数、阳性淋巴结数目作为分析因素.对8项变量进行单因素分析,比较两组之间的差异,分析直肠癌局部复发的相关危险因素.计数资料采用x2检验,计量资料先进行正态性检验,正态分布资料采用两独立样本t检验,非正态分布资料采用两独立样本Wileoxon秩和检验.多因素分析采用Logistic回归模型.结果 本组患者随访至2013年1月,中位随访时间为52个月,复发组患者死亡22例,未复发组患者死亡32例.单因素分析结果表明:复发组和未复发组患者在肿瘤位置、T分期方面比较,差异有统计学意义(x2=6.407,9.652,P＜0.05).两组患者在术后化疗、肿瘤分化程度、脉管或神经浸润、肿瘤直径、获取淋巴结总数、阳性淋巴结数目方面比较,差异无统计学意义(x2=1.349,0.342,0.656,Z=7142.5,8214.5,7241.5,P＞0.05).多因素分析结果表明:肿瘤位置(低位)、T分期(T4期)是影响直肠癌根治性切除术后局部复发的因素(Wald=3.954,5.615,P＜0.05).进一步分析结果表明:与高位直肠癌患者比较,中位直肠癌局部复发率没有明显改变(OR=1.893,P＞0.05)；而低位直肠癌局部复发率则明显升高(OR=3.201,P＜0.05).与T2期患者比较,T3期直肠癌患者局部复发率没有明显改变(OR=4.913,P＞0.05)；T4期直肠癌患者局部复发率明显升高(OR=16.103,P＜0.05).结论 低位直肠癌和T分期影响直肠癌根治性切除术后患者肿瘤局部复发,手术根治程度指标对于判断此类患者预后、指导后续治疗意义重大.
目的 分析影響直腸癌根治性切除術後跼部複髮的危險因素.方法 迴顧性分析2000年1月至2009年3月中山大學附屬第六醫院行直腸癌根治性切除術後穫得完整隨訪150例患者的臨床資料.其中跼部複髮的患者(複髮組)50例,按照性彆相同,年齡相差≤3歲進行1∶2配對,挑選齣100例直腸癌根治性切除術後未跼部複髮患者(未複髮組)作為對照.篩選齣腫瘤位置、術後化療、腫瘤分化程度、脈管或神經浸潤、T分期、腫瘤直徑、穫取淋巴結總數、暘性淋巴結數目作為分析因素.對8項變量進行單因素分析,比較兩組之間的差異,分析直腸癌跼部複髮的相關危險因素.計數資料採用x2檢驗,計量資料先進行正態性檢驗,正態分佈資料採用兩獨立樣本t檢驗,非正態分佈資料採用兩獨立樣本Wileoxon秩和檢驗.多因素分析採用Logistic迴歸模型.結果 本組患者隨訪至2013年1月,中位隨訪時間為52箇月,複髮組患者死亡22例,未複髮組患者死亡32例.單因素分析結果錶明:複髮組和未複髮組患者在腫瘤位置、T分期方麵比較,差異有統計學意義(x2=6.407,9.652,P＜0.05).兩組患者在術後化療、腫瘤分化程度、脈管或神經浸潤、腫瘤直徑、穫取淋巴結總數、暘性淋巴結數目方麵比較,差異無統計學意義(x2=1.349,0.342,0.656,Z=7142.5,8214.5,7241.5,P＞0.05).多因素分析結果錶明:腫瘤位置(低位)、T分期(T4期)是影響直腸癌根治性切除術後跼部複髮的因素(Wald=3.954,5.615,P＜0.05).進一步分析結果錶明:與高位直腸癌患者比較,中位直腸癌跼部複髮率沒有明顯改變(OR=1.893,P＞0.05)；而低位直腸癌跼部複髮率則明顯升高(OR=3.201,P＜0.05).與T2期患者比較,T3期直腸癌患者跼部複髮率沒有明顯改變(OR=4.913,P＞0.05)；T4期直腸癌患者跼部複髮率明顯升高(OR=16.103,P＜0.05).結論 低位直腸癌和T分期影響直腸癌根治性切除術後患者腫瘤跼部複髮,手術根治程度指標對于判斷此類患者預後、指導後續治療意義重大.
목적 분석영향직장암근치성절제술후국부복발적위험인소.방법 회고성분석2000년1월지2009년3월중산대학부속제륙의원행직장암근치성절제술후획득완정수방150례환자적림상자료.기중국부복발적환자(복발조)50례,안조성별상동,년령상차≤3세진행1∶2배대,도선출100례직장암근치성절제술후미국부복발환자(미복발조)작위대조.사선출종류위치、술후화료、종류분화정도、맥관혹신경침윤、T분기、종류직경、획취림파결총수、양성림파결수목작위분석인소.대8항변량진행단인소분석,비교량조지간적차이,분석직장암국부복발적상관위험인소.계수자료채용x2검험,계량자료선진행정태성검험,정태분포자료채용량독립양본t검험,비정태분포자료채용량독립양본Wileoxon질화검험.다인소분석채용Logistic회귀모형.결과 본조환자수방지2013년1월,중위수방시간위52개월,복발조환자사망22례,미복발조환자사망32례.단인소분석결과표명:복발조화미복발조환자재종류위치、T분기방면비교,차이유통계학의의(x2=6.407,9.652,P＜0.05).량조환자재술후화료、종류분화정도、맥관혹신경침윤、종류직경、획취림파결총수、양성림파결수목방면비교,차이무통계학의의(x2=1.349,0.342,0.656,Z=7142.5,8214.5,7241.5,P＞0.05).다인소분석결과표명:종류위치(저위)、T분기(T4기)시영향직장암근치성절제술후국부복발적인소(Wald=3.954,5.615,P＜0.05).진일보분석결과표명:여고위직장암환자비교,중위직장암국부복발솔몰유명현개변(OR=1.893,P＞0.05)；이저위직장암국부복발솔칙명현승고(OR=3.201,P＜0.05).여T2기환자비교,T3기직장암환자국부복발솔몰유명현개변(OR=4.913,P＞0.05)；T4기직장암환자국부복발솔명현승고(OR=16.103,P＜0.05).결론 저위직장암화T분기영향직장암근치성절제술후환자종류국부복발,수술근치정도지표대우판단차류환자예후、지도후속치료의의중대.
Objective To investigate the risk factors for locally recurrent rectal cancer after radical resection.Methods The clinical data of 50 locally recurrent rectal cancer patients (recurrent group) and 100 matched controls (control group) who received radical resection at the Sixth Affiliated Hospital of Sun Yat-Sen university from January 2000 to March 2009 were retrospectively analyzed.Factors including tumor location,postoperative chemotherapy,tumor differentiation,vascular or neural invasion,T stage,tumor diameter,number of lymph nodes dissected and number of positive lymph nodes of the 2 groups were analysed by univariate analysis,and factors correlated with tumor recurrence were screened out.All data were analyzed using the chi-square test,t test,Wilcoxon test or Logistic regression analysis.Results All the patients were followed up till January 2013,and the median time of follow-up was 52 months.Twenty-two patients in the recurrent group and 32 patients in the control group died during the follow-up.The results of univariate analysis showed that there were significant differences in tumor location and T stage between the 2 groups (x2 =6.407,9.652,P ＜ 0.05).There were no significant differences in postoperative chemotherapy,tumor differentiation,vascular and neural invasion,tumor diameter,number of lymph nodes dissected and number of positive lymph nodes between the 2 groups (x2 =1.349,0.342,0.656,Z =7142.5,8214.5,7241.5,P ＞ 0.05).The results of multivariate analysis showed that tumor location and T stage were the factors correlated with the tumor recurrence after radical resection (Wald =3.954,5.615,P ＜ 0.05).Compared with upper rectal cancer,the local recurrence rate was not significantly different in the middle rectal cancer (OR =1.893,P ＞ 0.05),whereas the lower rectal cancer had a higher local recurrence rate (OR =3.201,P ＜0.05).Compared with patients in T2 stage,the local recurrence rate was not significantly different in patients in T3 stage (OR =4.913,P ＞0.05),while patients in T4 stage had a higher local recurrence rate (OR =16.103,P ＜ 0.05).Conclusion Locally recurrent rectal cancer is closely related to tumor location and T stage,which indicates that factors reflecting the extent of surgical resection (such as circumferential margin) are of great importance in assessing the prognosis and making subsequent treatment schedule.
