结直肠腺癌病理分型的临床意义及预后分析

The clinical significance of pathologic typing of colorectal adenocarcinoma and its prognostic analysis

目的探讨结直肠黏液腺癌、印戒细胞癌与乳头状、管状腺癌临床病理的差异和预后。方法收集1994年8月至2007年3月结直肠手术患者2089例，其中黏液腺癌144例，印戒细胞癌25例，乳头状腺癌和管状腺癌1837例，剔除其他类型肠道肿瘤83例。比较三组的临床病理特点。对影响结直肠预后的部分临床病理指标，如年龄、肿瘤部位、分期、腹膜、病理分型进行单因素和非条件Logistic回归分析。对三组进行总体生存分析。结果黏液腺癌患者发病的中位年龄为（54．20±16．25）岁，印戒细胞癌患者为（40．43±12．88）岁，乳头状腺癌和管状腺癌患者为（58．73±13．62）岁，印戒细胞癌发病年龄最低（P〈0．001）。三组男女比例、肿瘤直径、肿瘤部位、TNM分期、腹膜转移、淋巴结转移和脏器侵犯差异均有统计学意义（P值均〈0．05）。经单因素和非条件Logistic回归分析发现，黏液癌和印戒细胞癌是预示结直肠癌预后的危险因素，而印戒细胞癌是预示结直肠癌预后的独立因素。三组总体生存时间和生存率间差异有统计学意义（P〈0．001）。结论结直肠黏液腺癌和印戒细胞癌预后较乳头状、管状腺癌差。黏液癌和印戒细胞癌是预示结直肠癌预后的危险因素。

Objective To investigate the clinicopathological difference and prognosis of colorectal adenocarcinomas including mucinous, Signet-ring cell, papillary and tubular carcinomas. Methods Two thousand and eighty-nine patients with colorectal cancer underwent colorectal operation between August 1994 and April 2007. The clinicopathological characteristics of mucinous adenocarcinoma （n= 144 ）, signet-ring cell carcinoma （n= 25）, papillary and tubular carcinomas （n= 1837） were compared expect of other types of cancer （n = 83）. The single factor and Logistic regression methods were used to analyze the clinicopathological parameters that influence the prognosis of colorectal cancer such as age, location of the tumor, staging, peritoneum and pathological typing. The survival rates of patients with above three types of adenocarcinomas were analyzed. Results The mean age of onset was lowest in patients with mucinous adenocarcinomas [（54. 20 ±16. 25） years] compared with that in patients with signet-ring cell cancer [（40.43± 12.88）years] or papillary and tubular carcinomas [ （58.73± 13.62） ]. There were significant differences in gender, size and location of the tumor, TNM staging, peritoneal metastasis, lymph node involvement and adjacent organ invasion among three groups （all P values 〈0.05）. The single factor and Logistic regression analysis revealed that both mucinous adenocarcinoma and signet-ring cell carcinoma were risk factors of prognosis. The patients with mucinous adenocarcinoma or signet-ring cell tumor were poor in longterm overall survival in comparison with patients with papillary and tubular carcinoma （P〈0. 001）. Conclusions The colorectal mucinous and signet-ring cell adenoearcinomas are risk factors for prognosis of colorectal cancer, which imply the poor outcome.