直肠癌根治性切除术后局部复发的危险因素分析

Risk factors for local recurrence after radical resection of rectal cancer

目的分析影响直肠癌根治性切除术后局部复发的危险因素。方法回顾性分析2000年1月至2009年3月中山大学附属第六医院行直肠癌根治性切除术后获得完整随访150例患者的临床资料。其中局部复发的患者（复发组）50例，按照性别相同，年龄相差≤3岁进行1：2配对，挑选出100例直肠癌根治性切除术后未局部复发患者（未复发组）作为对照。筛选出肿瘤位置、术后化疗、肿瘤分化程度、脉管或神经浸润、T分期、肿瘤直径、获取淋巴结总数、阳性淋巴结数目作为分析因素。对8项变量进行单因素分析，比较两组之间的差异，分析直肠癌局部复发的相关危险因素。计数资料采用，检验，计量资料先进行正态性检验，正态分布资料采用两独立样本t检验，非正态分布资料采用两独立样本Wileoxon秩和检验。多因素分析采用Logistic回归模型。结果本组患者随访至2013年1月，中位随访时间为52个月，复发组患者死亡22例，未复发组患者死亡32例。单因素分析结果表明：复发组和未复发组患者在肿瘤位置、T分期方面比较，差异有统计学意义（X2=6．407，9．652，P〈0．05）。两组患者在术后化疗、肿瘤分化程度、脉管或神经浸润、肿瘤直径、获取淋巴结总数、阳性淋巴结数目方面比较，差异无统计学意义（X2=1．349，0．342，0．656，Z=7142．5，8214．5，7241．5，P〉0．05）。多因素分析结果表明：肿瘤位置（低位）、T分期（T4期）是影响直肠癌根治性切除术后局部复发的因素（Wald=3．954，5．615，P〈0．05）。进一步分析结果表明：与高位直肠癌患者比较，中位直肠癌局部复发率没有明显改变（OR=1．893，P〉0．05）；而低位直肠癌局部复发率则明显升高（OR=3．201，P〈0．05）。与他期患者比较，T3期直肠癌患者局部复发率没有明显改变（OR=4．913，P〉0．05）；T4期直肠癌患者局部复发率明显升高（OR=16．103，P〈0．05）。结论低位直肠癌和T分期影响直肠癌根治性切除术后患者肿瘤局部复发，手术根治程度指标对于判断此类患者预后、指导后续治疗意义重大。

Objective To investigate the risk factors for locally recurrent rectal cancer after radical resec- tion. Methods The clinical data of 50 locally recurrent rectal cancer patients （recurrent group） and 100 matched controls （control group） who received radical resection at the Sixth Affiliated Hospital of Sun Yat-Sen university from January 2000 to March 2009 were retrospectively analyzed. Factors including tumor location, postoperative chemotherapy, tumor differentiation, vascular or neural invasion, T stage, tumor diameter, number of lymph nodes dissected and number of positive lymph nodes of the 2 groups were analysed by univariate analysis, and factors correlated with tumor recurrence were screened out. All data were analyzed using the ehi-square test, t test, Wilcoxon test or Logistic regression analysis. Results All the patients were followed up till January 2013, and the median time of follow-up was 52 months. Twenty-two patients in the recurrent group and 32 patients in the control group died during the follow-up. The results of univariate analysis showed that there were significant differ- ences in tumor location and T stage between the 2 groups （X2= 6. 407, 9. 652, P 〈 0.05）. There were no signifi- cant differences in postoperative chemotherapy, tumor differentiation, vascular and neural invasion, tumordiameter, number of lymph nodes dissected and number of positive lymph nodes between the 2 groups （X2 = 1. 349, 0. 342, 0. 656, Z = 7142. 5,8214.5,7241.5, P 〉 0.05 ）. The results of multivariate analysis showed that tumor location and T stage were the factors correlated with the tumor recurrence after radical resection （ Wald = 3. 954, 5. 615, P 〈 0.05）. Compared with upper rectal cancer, the local recurrence rate was not significantly different in the middle rectal cancer （ OR = 1. 893, P 〉 0.05 ） , whereas the lower rectal cancer had a higher local recurrence rate （ OR = 3. 201, P 〈 0.05 ）. Compared with patients in T2 stage, the local recurrence rate was not significantly different in patients in T3 stage （ OR =4. 913, P 〉0.05） , while patients in T4 stage had a higher local recurrence rate （ OR = 16. 103, P 〈 0.05 ）. Conclusion Locally recurrent rectal cancer is closely related to tumor location and T stage, which indicates that factors retleeting the extent of surgical resection （such as circumferential margin） are of great importance in assessing the prognosis and making subsequent treatment schedule.