287例直肠癌术后预后因素的回顾性分析

A Retrospective Analysis of Prognostic Factors for 287 Patients with Rectal Cancer Resection

目的探讨影响直肠癌患者术后长期生存的相关因素.方法以2002年1月至2013年12月延安大学附属医院普通外科收治的287例直肠癌手术患者为研究目标,利用Cox比例风险模型分析影响直肠癌患者术后生存的相关因素,Kaplan-Meier方法绘制生存曲线,对数秩检验检验不同组别间的统计学意义.结果术前癌胚抗原水平、病理分型、TNM分期、淋巴结转移度是直肠癌术后患者长期生存的相关因素;高分化直肠癌患者的生存率高(P<0.05),术前化疗联合术后化疗以及术后联合放化疗的综合治疗方式提高患者的生存率(P<0.05);直肠癌局限于粘膜、粘膜下层的生存率要高于肿瘤已经浸润其他器官或组织(P<0.05);而手术方式与直肠癌术后患者的长期生存无关(P=0.119).结论直肠癌的TNM分期、淋巴结转移度、病理分型是影响直肠癌患者术后长期生存的重要因素.

Objective To investigate the prognostic factors related to the long- term survival following rectal cancer excision. Methods A total of 287 patients with rectal cancer who underwent rectal cancer excision in our hospital from 2002 to 2013 were analyzed retrospectively, and 163 patients were male, 124 patients were female.The patients age ranged from 28-79 years and average age was 58.1±13.82 years. The TNM stage was stageⅠ53cases（18.5%）,stageⅡ97 cases（33.8%）,stageⅢ115 cases（40.1%）,stageⅣ22 cases（7.6%）. Tumor differentiation degree was undifferentiated 22 cases（7.6%） low differentiation 37 cases（12.9%）, middle differentiation 149 cases（51.9%）,and high differentiation 79 cases（27.6%）. Cox proportional hazards model was used to analyze to find factors affecting survival of patients with rectal cancer. Kaplan- Meier method was applied to analyze survival rates, and Log- rank test was performed to assess statistical significance among these groups.Results Preoperative CEA levels（P〈0.05）,pathological classification（P〈0.05）, TNM stage（P〈0.05）,lymph nodes metastatic ratio（P〈0.05） were related with post- operative survival. Patients with well differentiated tumors had a higher survival rate than that in poorly differentiated or undifferentiated tumors. Preoperative plus postoperative chemotherapy and preoperative radiotherapy plus postoperative chemotherapy had higher survival rates than other treatments. Tumor Limited to the mucosa and submucosa had higher survival rates than other parts（P〈0.05）. However, surgical procedures had nothing to do with postoperative long- term survival in patients with rectal cancer（P=0.119）. Conclusions TNM stage, lymph nodes metastatic ratio and pathological classification are the important factors influencing the prognosis of rectal cancer. Early diagnosis of rectal cancer and comprehensive treatments are the keys to improve the rectal cancer postoperative survival rate.