中低位直肠癌肿瘤复发的影响因素

Factors Influencing Recurrence in Low and Mid Rectal Cancer

目的分析影响中低位直肠癌肿瘤复发的因素.方法1990年3月-1996年3月收治的中低位直肠癌患者484例,经腹会阴联合切除术（abdominoperineal resection,APR）356例、低位前切除术（low anterior resection,LAR）128例后,依据术后复发的随访结果对肿瘤因素分别进行单因素与多因素回顾性统计分析,从而筛检对肿瘤复发的影响具有独立特性的高危因素.结果五年总的复发率为15.9%,其中APR与LAR分别为：21.5%、1.6%（P〉0.05）;五年累积的生存率为72.6%,其中肿瘤复发组与未复发组分别为：27.1%、80.4%（P〈0.01）.Cox比例风险模型显示：孤立癌巢（R1）、TNM分期（T3N0M0、T1-3N1-2M0、TanyN1-3M0）及肿瘤大小（3.1-5.0cm）对肿瘤复发的影响具有独立特性.结论中低位直肠癌孤立癌巢（R1）、TNM分期（T3N0M0、T1-3N1-2M0、TanyN1-3M0）及肿瘤大小（3.1-5.0cm）是影响肿瘤复发的高危因素,可作为临床评估的重要指标.

Objective To evaluate risk factors bearing independent effect on recurrence in low and mid rectal cancer.Methods 484 consecutive patients with low and mid rectal cancer were treated by the abdominoperineal resection（APR）（356 patients） and the low anterior resection（LAR）（128 patients） from March 1990 to March 1996. The tumor variables were evaluated both univariately and multivariately from the perspective of first recurrence to determine independent risk factors.Results The actuarial 5-year recurrence rate was 15.9%,among which 21.5%for APR and 1.6% for LAR/SSR,respectively（P〉0.05）.The 5-year actuarial survival rate for all patients was 72.6%,27.1% for the recurrent group and 80.4% for the non-recurrent group,respectively（P〈0.01）.The resulting multivariate analysis using Cox regression showed that the three tumor variables were significantly（P〈0.01） associated with the recurrence：residual classification（R1）,TNM stages（T3N0M0,T1-3N1-2M0,TanyN1-3M0）,and tumor size（3.1-5.0cm）.Conclusion The three tumor variables identified in multivariate analysis as bearing the strongest independent effect on the recurrence in low and mid rectal cancer were residual classification（R1）,TNM stages（T3 N0M0,T1-3N1-2M0,TanyN1-3M0）,and tumor size（3.1-5.0cm）.These risk factors may be used as important bases for clinical evaluation.