临床病理因素在结肠癌和直肠癌预后中的不同作用

Influence of clinical and pathomorphological parameters on prognosis in colon carcinoma and rectal carcinoma

目的:研究各临床病理因素对结肠癌和直肠癌预后影响的区别,并分析根治术后直肠癌患者的预后因素。方法:运用单因素及多因素COX比例风险模型分别对101例结肠癌、219例直肠癌及137例根治术后的直肠癌患者进行生存分析。结果:经单因素分析显示,发生淋巴结转移、远处转移是结肠癌和直肠癌预后共同的不利因素,吸烟、浸润达浆膜外、未化疗和血清白蛋白含量低是结肠癌的可疑不利因素,印戒细胞癌、肿块大于6 cm、浸润达浆膜外、未行根治性手术和TNM分期高则是直肠癌的不利因素。根治术后的直肠癌病例,浸润深度深、发生淋巴结转移、脉管侵犯、肿瘤间质淋巴细胞浸润少、无C rohn样反应、肿瘤芽多、TNM分期高和尿糖阳性是不利因素。多因素分析显示,与结肠癌有关的独立预后因素为吸烟、淋巴结转移和血清白蛋白含量;直肠癌的独立预后因素包括远处转移、TNM分期和手术方案;根治术后的直肠癌患者独立预后因素包括脉管侵犯、淋巴结转移与尿糖。结论:吸烟、淋巴结转移和血清白蛋白含量是结肠癌的独立预后因素;远处转移、TNM分期和手术方案是直肠癌的独立预后因素。对于根治术后的直肠癌患者,脉管侵犯、淋巴结转移和尿糖是独立的预后因素。

Objective： To investigate the effects of clinical and pathomorphological parameters on the prognosis of colon carcinoma and rectal carcinoma. Methods： Univariate and multivariate COX proportional hazard models were used to study the effects of the clinical and pathomorphological factors on the prognosis in 101 cases of colon carcinoma, 219 of rectal carcinoma and 137 of rectal carcinoma under curative resections. Results： By using univariate analysis, we identified that lymph node metastasis and distant metastasis were the common prognostic factors for both colon carcinoma and rectal carcinoma. Smoking, deep infiltration, chemotherapy and serum albumin concentration were the uncertain prognostic factors for colon carcinoma. Signet-ring cell carcinoma,larger tumor size （〉6 cm）,deep infiltration,lack of radical surgery, and advanced TNM stage were the exclusive adverse prognostic factors for rectal carcinoma. Further studies showed that the adverse prognostic factors for the rectal carcinoma under curative resection included deep infiltration,lymph node metastasis,vessel invasion,less of peritumoral lymphocyte infiltration,lack of Crohn＇s like reactivity,high level of tumor budding, advanced TNM stage and positive urine glucose. By using multivariate analysis based on a COX proportional hazard model, it was identified that smoking, lymph node metastasis and serum albumin concentration were independent prognostic factors for colon carcinoma; advanced TNM stage, distant metastasis and palliative surgery for rectal carcinoma ; and vessel invasion, lymph node metastasis and urine glucose for rectal carcinoma under curative resections. Conclusion. The various clinical and pathomorphological parameters show different prognostic value for colon carcinoma ,rectal carcinoma and rectal carcinoma under curative resections.