简化大肠癌大体类型的临床意义

Exploration on the modification of macroscopic classification of colorectal cancer

目的探讨简化大肠癌大体分型的可行性和临床意义。方法回顾性分析1379例有完整随访记录的大肠癌患者的临床资料，所有患者按照大体类型分组：1组为隆起型，2组为限局溃疡型，3组为浸润性，4组为浸润溃疡型；简化分型后，A组为限局型，B组为浸润型。比较原大体分型和简化大体分型与大肠癌组织学类型、肠壁浸润深度、淋巴结转移程度、淋巴结转移数量之间的关系以及对患者生存期的影响。结果在低级别大肠癌比例、大肠癌浸润深度、淋巴结转移程度、淋巴结转移数量和5年生存率等指标上，1组和2组、3组和4组之间的差异均无统计学意义（均P〉0．05）；而3、4组的上述指标分别与1、2组相比，差异有统计学的意义（均P〈0．05），即浸润型和浸润溃疡型癌的组织学分化程度更差、肠壁浸润更深、淋巴结转移更严重。简化分型后，A、B两组的组织学分化程度、肠壁浸润深度、淋巴结转移程度、淋巴结转移数量和5年生存率的差异均有统计学意义（均P〈0．05）。结论原大肠癌大体分型中，隆起型和限局溃疡型、浸润型和浸润溃疡型的临床病理学特征相似，可以通过分别合并达到简化大体分型的目的。简化大体分型在临床医生对大肠癌的诊断治疗和预后判断中均有重要的指导意义。

Objective To explore the feasibility and clinical significance of a modified macroscopic classification of colorectal cancer. Methods The data of 1379 patients with colorectal cancer surgically treated between 1975 and 2003 were retrospectively analyzed. The patients were divided into four groups according to the primary macroscopic appearance： protruding type （group 1 ）, local ulcerative type （group 2）, invasive type （ group 3 ） and non-invasive ulcerative type （ group 4）. The new classification system was simplified into two types： non-invasive type （group A, including group 1 and 2） and invasive type （group B, including group 3 and 4）. The histo-differentiation, invasive depth into the intestinal wall, distance and number of lymph node metastasis and 5-year survival rate were analyzed and compared among the groups. Results There was no significant difference between group 1 and 2, and between group 3 and 4 in histodifferentiation, invasive depth into the intestinal wall, distance and number of lymph node metastasis and 5- year survival rate （P 〉 0.05 ）. However, after modification of the primary macroscopic classification, a significant difference was observed in all the above mentioned parameters between group A and group B （ P 〈 0.05）. Conclusion Our results demonstrate that the clinicopathological characteristics of the group 1 and 2, and of the group 3 and 4 are similar to each other. So it is reasonable to merge the protruding type and local ulcerative type into non-invasive type, while invasive type and non-invasive ulcerative type into invasive type. This simplified macroscopic classification should be practical and instructive in diagnosis, treatment and prognosis of colorectal cancer.