Dukes D期直肠癌的预后分析及治疗策略

Prognosis analysis and treatment strategy for patients with Dukes D stage rectal cancer

目的:探讨Dukes D期直肠癌的转移分布、预后及治疗策略.方法:收集1979-05/2003-08我院诊断为DukesD直肠癌并行手术干预治疗的患者301例,运用Log-rank和Kapla-Meier检测方法回顾性分析患者临床病理资料,直肠癌的类型分布及预后.结果:Dukes D期直肠癌患者平均生存32.50±3.22mo,1、3、5年整体生存率为64.61%、26.40%和15.15%;肿瘤的大体类型、组织类型、浸润深度和手术方式影响患者的预后;行单纯造瘘的病例占32.56%,姑息性手术的病例占67.44%,且行姑息性手术者生存显著获益(P=0.0158);伴有腹膜种植的病例占10.29%,伴有局部浸润的病例占32.55%,伴有远处转移的病例占40.53%,术中伴有复合转移(合并两种或两种以上转移类型)的病例占16.61%,其预后无差异(P=0.4122);发生肝转移的病例占所有病例的51.4%,占所有远处转移患者的84.23%,平均生存时间为32.50±3.22mo,行根治术者的生存时间相对较长.结论:Dukes D期直肠癌中,各种转移类型的病例预后无差异,手术切除原发灶可助患者生存获益.

AIM： To evaluate the metastasis distribution, prognosis and treatment strategy for patients with Dukes D stage rectal cancer. METHODS： Clinical data, type distribution and prognosis of 301 cases with Dukes D stage rectal cancer who underwent surgery from May 1991 to August 2003 were retrospectively analyzed using Log-rank and Kapla-Meier test. RESULTS： The patients with Dukes D stage were associated with a mean OS （overall survival） of 32.50 ± 3.22 months, and OS rate were 64.61% （1 year）, 26.40% （3 years） and 15.15% （5 years）, respectively. The prognosis was related to factors such as gross type, tumor differentiation, T stage and surgery type. 32.56% patients underwent side-side anastomosis and no primary-cancer-directed surgery, and 67.44% patients underwent primary-cancer-directed surgery. Patients had significantly benefited from palliative resection in terms of overall survival （P = 0.0158）. The patients with Dukes D stage were 10.29% with peritoneal carcinomatosis, 32.55% with local infiltration, 40.53% with distant metastasis, and 16.61% with complex metastasis. The prognosis among metastasis type was not significantly different （P = 0.4122）. Patients with synchronous liver metastases accounted for 51.4% of all cases, and 84.23% for distant metastasis, which had a mean OS of 32.50 ± 3.22 months and had relatively longer life expectancy. CONCLUSION： Patients of Dukes D stage rectal cancer show no significant difference regardless of metastasis type, and primary-cancer-directed surgery should be actively performed and the postoperative OS rate and quality of life can be improved.