结直肠印戒细胞癌与黏液腺癌的临床病理特征及外科治疗比较研究

Clinicopathological features and surgical treatment of colorectal signet-ring cell carcinoma and colorectal mucinous carcinoma

目的:探讨结直肠印戒细胞癌与黏液腺癌在临床病理特点、外科治疗及预后方面的差异。方法:对1992年1月—2008年12月山东大学齐鲁医院普外科收治的67例结直肠印戒细胞癌、179例黏液腺癌患者的临床病理特点和外科治疗进行回顾性分析并进行随访。采用χ2检验分析其相关因素,Kaplan-M eier法进行生存分析,Log-rank检验和C ox检验分别进行预后相关因素的单因素、多因素分析。结果:印戒细胞癌与黏液腺癌在发病年龄、肿瘤部位、有无肠梗阻、手术方式、有无脉管瘤栓、浸润深度、淋巴结转移方面差异具有统计学意义(P<0.05)。在性别、术前C EA和肝转移方面差异无统计学意义(P>0.05)。印戒细胞癌中位生存期26个月,黏液腺癌中位生存期47个月,差异具有统计学意义(P<0.05)。多因素回归分析结果显示病理类型、手术方式为影响预后的独立因素。结论:结直肠印戒细胞癌恶性度高于黏液腺癌,病理类型和手术方式是独立的预后影响因素。根治性手术切除和姑息性减瘤手术可以有效改善预后。

Objective： To explore clinicopathologicalfeatures, surgicaltreatmentand prognosis of colorectalsignet-ring cell carcinoma and mucinous carcinoma. Methods： Retrospective analysis and follow-up were made on 67 patients with colorectalsignet-ring cellcarcinoma and 179 patients with mucinous carcinoma treated in department of gerneral surgery, Qilu Hospital of Shandong University from Jan.1992 to Dec. 2008. Obtained data were analyzed by SPSS17.0. Related factors were underw ent χ2analysis, survival analysis were estim ated using Kaplan-M eier method and compared using the Log-rank test and multiple-factors Cox analysis. Results： Colorectal signet-ring cellcarcinoma were significantly different from mucinous carcinoma in age, tum or location, bowel obstruction, operative modus, tum or embolism, tumor infiltration and lymph node metastasis（P0.05）. W hile the difference of such characteristics as gender, preoperative carcinoem bryonic antigen level and hepatic metastasis or not was not significant. Median survival time was 26 months in signet-ring cell carcinoma and 47 months in mucinous carcinoma and the difference is significant（P0.05）. Histologicalsubtype and operative modus were independent prognostic factors based on a multivariate analysis of the C ox Proportional Hazards Model. Conclusions：Malignancy of colorectal signet-ring cell carcinoma is higher than mucinous carcinoma. Radical resection and palliative cytoreductive surgery can improve prognosis effectively.