结直肠高度恶性腺癌的临床病理特点和预后分析

Colorectal high grade malignancy adenocarcinoma

目的比较三种结直肠高度恶性腺癌（印戒细胞癌、黏液腺癌与低分化腺癌）的临床病理特点及预后。方法对医科院肿瘤医院1988--2006年收治的有完整随访资料的148例结直肠黏液腺癌、55例印戒细胞癌和281例低分化腺癌的临床病理特点进行回顾性分析。应用SPSS13．0软件进行统计学分析，采用X^2检验分析其相关因素，Kaplan—Meier法进行生存分析，Log—rank检验进行统计学比较。结果结直肠印戒细胞癌、黏液腺癌和低分化腺癌在性别、发病年龄、肿瘤部位、有无肠梗阻、手术方式、脉管瘤栓、浸润深度、淋巴结转移和分期方面差异具有统计学意义（X^2=7．67，38．4，86．0，14．5，93．7，17．3，62．1，24．4，56．17，P〈0．05），印戒细胞癌中位生存期为24个月，黏液腺癌中位生存期为47个月，低分化腺癌中位生存期为49个月，差异有统计学意义（X^2=21．3，P〈0．05）。结论三种结直肠高度恶性腺癌（印戒细胞癌、黏液腺癌与低分化腺癌）是临床病理特点和预后不同的结直肠恶性肿瘤，印戒细胞癌的恶性度最高，预后差。

Objective To-explore clinicopathoiogical features and prognosis in a high grade malignancy group of colorectal mucinous carcinoma, signet-ring cell carcinoma and low-differentiated carcinoma. Methods Retrospective analysis and follow-up were made on 148 patients with colorectal mucinous carcinoma, 55 patients with signet-ring cell carcinoma and 281 low- differentiated carcinoma treated in our hospital from 1988 to 2006. Obtained data were analyzed by SPSS13.0. Related factors underwent X2 analysis, survival analysis were estimated using Kaplan-Meier method and compared using the Log-rank test. Results Colorectal signet-ring cell carcinoma were significantly different from mucinous carcinoma and low- differentiated carcinoma in gender, age, tumor location, bowel obstruction, operative modus, tumor embolism, tumor infiltration and lymph node metastasis （ X^2 = 7.67,38.4,86.0,14. 5,93.7, 17.3,62. 1,24.4,56. 17 ,P 〈 0.05 ）. Median survival time was 24 months in signet-ring cell carcinoma, 47 months in mucinous carcinoma and 49 months in low- differentiated carcinoma. The difference is of significance（ X^2 = 21.3, P 〈 0. 05 ）. Conclusions Clinicopathological characteristics and prognosis of colorectal signet-ring cell carcinoma, mucinous carcinoma and low- differentiated carcinoma is of significant difference（ P 〈 0. 05 ）. Malignancy of signet-ring cell carcinoma is higher with worse prognosis.