CAJ | 학술논문

目的探讨Ⅱ、Ⅲ期结肠癌根治术后肿瘤复发转移的危险因素.方法回顾性分析628例Ⅱ、Ⅲ期结肠癌根治术患者的临床资料,以Kaplan-Meier法比较生存差异,Cox单因素和多因素分析复发转移的危险因素.结果中位随访58个月,随访期内,179例患者出现复发转移.全组患者的5年无病生存率和总生存率分别为70.3％和78.5％.单因素分析结果显示,年龄、吸烟状况、T分期、淋巴结转移情况、有无癌结节、肿瘤大体形态、TNM分期、分化程度、是否有脉管瘤栓、术后辅助化疗方案、术前和术后CEA水平、术前和术后CA19-9水平以及是否为双原发癌与Ⅱ、Ⅲ期结肠癌根治术后肿瘤的复发转移相关(均P ＜0.05).多因素分析结果显示,区域淋巴结转移、术后辅助化疗方案为单药氟尿嘧啶类、TNM分期为Ⅲ期、术前CEA和CA19-9升高是影响Ⅱ、Ⅲ期结肠癌根治术后肿瘤复发转移的独立危险因素(均P ＜0.05).结论区域淋巴结转移、术后辅助化疗方案为单药氟尿嘧啶类、TNM分期为Ⅲ期、术前CEA和CA19-9升高是影响Ⅱ、Ⅲ期结肠癌根治术后肿瘤复发转移的独立危险因素.
목적 탐토Ⅱ、Ⅲ기결장암근치술후종류복발전이적위험인소.방법 회고성분석628례Ⅱ、Ⅲ기결장암근치술환자적림상자료,이Kaplan-Meier법비교생존차이,Cox단인소화다인소분석복발전이적위험인소.결과 중위수방58개월,수방기내,179례환자출현복발전이.전조환자적5년무병생존솔화총생존솔분별위70.3％화78.5％.단인소분석결과현시,년령、흡연상황、T분기、림파결전이정황、유무암결절、종류대체형태、TNM분기、분화정도、시부유맥관류전、술후보조화료방안、술전화술후CEA수평、술전화술후CA19-9수평이급시부위쌍원발암여Ⅱ、Ⅲ기결장암근치술후종류적복발전이상관(균P ＜0.05).다인소분석결과현시,구역림파결전이、술후보조화료방안위단약불뇨밀정류、TNM분기위Ⅲ기、술전CEA화CA19-9승고시영향Ⅱ、Ⅲ기결장암근치술후종류복발전이적독립위험인소(균P ＜0.05).결론 구역림파결전이、술후보조화료방안위단약불뇨밀정류、TNM분기위Ⅲ기、술전CEA화CA19-9승고시영향Ⅱ、Ⅲ기결장암근치술후종류복발전이적독립위험인소.
Objective To analyze the clinicopathologic factors related to recurrence and metastasis of stage Ⅱ or Ⅲ colon cancer after radical resection.Methods The clinical and pathological data of 628 patients with stage Ⅱ or Ⅲ colon cancer after radical resection from Jan.2005 to Dec.2008 in our hospital were retrospectively reviewed and analyzed.Results The overall recurrence and metastasis rate was 28.5％ (179/628).The 5-year disease-free survival (DFS) rate was 70.3％ and 5-year overall survival (OS) rate was 78.5％.Univariate analysis showed that age,smoking intensity,depth of tumor invasion,lymph node metastasis,TNM stage,gross classification,histological differentiation,blood vessel tumor embolus,tumor gross pathology,multiple primary tumors,preoperative and postoperative serum concentration of CEA and CA19-9,and the regimen of adjuvant chemotherapy were correlated to recurrence and metastasis of colon cancer after radical resection.Multivariate analysis showed that regional lymph node metastasis,TNM stage,the regimen of postoperative adjuvant chemotherapy,and preoperative serum concentration of CEA and CA19-9 were independent factors affecting the prognosis of colon cancer patients.Conclusion Regional lymph node metastasis,TNM stage,elevated preoperative serum concentration of CEA and CA19-9,the regimen of postoperative adjuvant chemotherapy with single fluorouracil type drug are independent risk factors of recurrence and metastasis in patients with stage Ⅱ-Ⅲ colon cancer after radical resection.