中下段直肠癌系膜环周切缘的临床研究

A clinical study on the circumferential resection margin in patients with middle and lower rectal carcinoma

目的探讨中下段直肠癌系膜环周切缘与直肠癌预后的相关性,分析环周切缘与临床病理特征的关系。方法采用病理大切片技术,前瞻性研究56例中下段直肠癌直肠系膜环周切缘侵犯情况。结果中下段直肠癌根治性切除术后局部复发率为13%（7/56）,远处复发率为25% （14/56）;中下段直肠癌直肠系膜环周切缘阳性率为21%（12/56）;环周切缘阳性的中下段直肠癌局部复发率为33%（4/12）,明显高于环周切缘阴性的7%（3/44）（χ^2=6.061,P=0.014）;前者远处复发率为50%（6/12）,后者为18%（8/44）（χ^2=5.091,P=0.024）。Kaplan-Meier生存分析显示,环周切缘与生存时间密切相关（log-rank,P=0.011）;环周切缘阳性的中下段直肠癌患者3年生存率为41.7%,明显低于环周切缘阴性者的70.4%。T3直肠癌环周切缘阳性率为37%（10/27）,明显高于T1和T2的0/6和9%（2/23）（χ^2=7.758,P=0.021）。肿瘤直径≥5 cm直肠癌环周切缘阳性率为39%（7/18）,明显高于肿瘤直径〈5 cm的13%（5/38）（χ^2=4.803,P=0.028）。结论环周切缘侵犯与浸润深度和肿瘤直径密切相关,是影响中下段直肠癌预后的重要因素。

Objective To clarify the relationship between circumferential resection margin status and local and distant recurrence as well as survival of patients with middle and lower rectal carcinoma, and to identify the correlations between circumferential resection margin status and elinieopathologie characteristics of patients with middle and lower rectal carcinoma. Methods Specimens from 56 patients with middle and lower rectal carcinoma undergoing total mesorectal excision in our hospital were studied. Results Local recurrence developed in 13% （7/56） of all patients with middle and lower rectal carcinoma, and the distant recurrence was 25% （14/56）. In the 12 patients （21%） with positive circumferential resection margin, the local recurrence rate was 33 % （4/12）, whereas it was 7% （3/44） in those with negative circumferential resection margin （ χ^2 = 6. 061, P = 0. 014）. Distant recurrence was 50% （6/12） in patients with positive circumferential resection margin, compared with 18% （8/44） in those with negative circumferential resection margin （χ^2 = 5.091, P = 0. 024）. Kaplan-Meier survival analysis showed significant improvements in survival for circumferential resection margin-negative patients over circumferential resection margin-positive patients （log-rank, P =0. 011 ）. In this study 37% T3 tumors were with positive circumferential resection margin, in contrast with 0% T1 tumors and 9% T2 tumors （ χ^2 = 7. 758, P = 0. 021）. In 18 cancer specimens with tumor diameter≥5 cm, 7 （39%） were with positive circumferential resection margin, in 38 cancer specimens with tumor diameter 〈 5 cm only 5 （ 13% ） were with positive circumferential resection margin （χ^2 = 4. 803, P = 0. 028 ）. Conclusion The circumferential resection margin is associated with the depth of tumor invasion and tumor diameter. The circumferential resection margin status is an important predictor of local and distant recurrence as well as survival of patients with middle and lower rectal carcinoma.