Ⅲ期结直肠癌分期分层及其临床意义探讨

A new TNM subclassification for stage Ⅲ colorectal carcinoma and its clinical implications

目的 探讨结直肠癌新TNM分期系统的临床应用价值.方法 回顾性分析1997年11月至2002年7月诊治的192例Ⅲ期结直肠癌患者的临床病理资料,应用Log-rank检验和Cox比例风险模型分析Ⅲ期结直肠癌患者的预后因素.结果 选择根治性手术治疗的Ⅲ期结直肠癌患者192例,分为辅助化疗组和未化疗组.中位随访时间60个月,术后总5年生存率为51.0%.按AJCC第6版TNM分期标准进行分期后的5年生存率分别为ⅢA期77.8%、ⅢB期57.4%、ⅢC期33.3%,3组患者生存率比较差异有统计学意义（χ^2=17.99,P＜0.01）.辅助化疗组125例,未化疗组67例,按新TNM分期分组,ⅢA＋ⅢB患者辅助化疗组5年生存率71.4%,未化疗组38.1%,两组差异有统计学意义（χ^2=15.77,P＜0.01）,而ⅢC患者化疗和未化疗组预后差异无统计学意义（39.1%vs.24.0%,χ^2=1.94,P＞0.05）.新TNM分期对指导不同亚期的Ⅲ期患者进行个体化综合治疗具有临床实用价值.单因素分析显示：患者性别、年龄、原发肿瘤部位、手术方式与预后无关,而新TNM分期、肿瘤分化程度、CEA水平,是否接受化疗等因素与预后相关.Cox多因素分析表明,新TNM分期是反映Ⅲ期结直肠癌预后最主要的独立指标.结论 新TNM分期对估计Ⅲ期结直肠癌的预后更为精确、合理.ⅢC患者不论是否化疗预后均不满意.

Objective To assess the clinical value of the new TNM subclassification for stage Ⅲ colorectal carcinoma. Methods Clinical data of 192 patients of stage Ⅲ colorectal carcinoma undergoing curative resection from November 1997 to July 2002 were analyzed retrospectively. The prognostic factors were evaluated in a Cox proportional hazards model. Results Median postoperative follow-up time was 60 months. Overall 5-year survival rate was 51.0%. According to the new TNM classification by AJCC sixth edition system. The 5-year survival rate was 77. 8% for stage ⅢA, 57. 4% for stage ⅢB, 33.3% for stage Ⅲ C （P 〈 0. 01 ）. For stage Ⅲ A and Ⅲ B put together, the 5-year survival rate was 71.4% in those receiving postoperative chemotherapy and 38. 1% for cases without chemotherapy （P 〈 0.01 ）. For patients at stage ⅢC, the 5 year＇s survival rate did not vary with chemotherapy or without（39. 1% vs. 24. 0% ） （ P 〉 0.05）. By univariate analysis, four variables including the new TNM classification, tumor grade, CEA level and chemotherapy were related to overall survival （ P 〈 0. 05 ）. There was no correlation between prognosis and other clinicopathologial variables （ P 〉 0. 05 ）. Cox proportional hazards model study showed that the new TNM classification was the most significant independent prognostic factor. Conclusions The new TNM classification is an objective and reasonable system for stage Ⅲ colorectal carcinoma. Stage Ⅲ C patients had a poor prognosis with or without chemotherapy.