青年人与老年人直肠癌的临床病理与预后对比

Comparative study on clinicopathologic characteristics and prognosis between young ender patients with rectal cancer

目的探讨青年人与老年人直肠癌的临床病理特征及预后的差异。方法回顾1996年1月至2006年1月可手术的85例青年人（≤40岁）直肠癌与155例老年人（≥65岁）直肠癌患者的临床病理资料和随访资料，进行生存分析和预后多因素分析。结果青年人直肠癌发生在腹膜返折下占69.41％，高于老年组的52．90％（P=0．013）；低分化腺癌及黏液、印戒细胞癌比例分别为31．76％及22．35％，也分别高于老年组的18．71％及8．39％（P=0．023，P=0．007）；青年组有淋巴结转移者为63．53％，高于老年组的47．10％（P=0．015）；青年组与老年组的5生存率分别为48．2％、55．7％，两组差异无统计学意义（P=0．176）；多因素分析结果显示，手术性质、肿瘤侵犯深度、淋巴结转移、TNM分期是影响预后最重要的独立因素。结论与老年患者相比，青年患者直肠癌恶性度较高，发现较晚，但若能及早发现并通过根治手术为主联合放化疗，预后可与老年患者无差异。

Objective To investigate the differences of elinicopathologie characteristics and prognosis between young and old age patients with rectal cancer. Methods From January 1996 to January 2006, 85 young patients（age ≤40 years） and 155 older patients（age≥ 65 years）with rectal cancer were surgically treated. The clinicopathological and follow-up data of them were retrospectively analyzed and compared by survival analysis and COX regression multivariate analysis. Results Rectal cancer under peritoneal in young group were higher than that in older group （69.41% vs 52.90 %, P =0.013）. The young group had significantly higher frequencies of pooly differentiated carcinoma （31.76 % vs 18.71%, P =0.023） and more mutinous adenocarcinoma as well as signet-ring cell carcinoma （22.35 % vs 8.39 %, P =0.007）, There were more lymphatic metastasis in young group than that in old group （N1＋N2： 63.53 % vs 47.10 %, P =0.015）. The overall 5-year survival rates were 48.2 % and 55.7 % in young and old patients respectively, which was not significantly different （P =0.176）. COX regression showed that radical operation, tumor infiltration depth, lymph node metastasis and TNM stage were independent prognostic factors. Conclusion As compared to the old age patients, more malignancy and more advanced stage are common in young patients with rectal cancer. However the efficacy of young patients is similar to the older counters by early detection and radical operation combined radiotherapy as well as chemotherapy.