直乙肠交界处癌与直肠癌及乙状结肠癌的预后比较

Comparison of Prognosis Among Recto- sigmoid Cancer,Rectal Neoplasm and Sigmoid Neoplasm

目的：探讨直乙肠交界处癌与直肠癌、乙状结肠癌预后的差异及影响因素。方法选取2008年1月—2012年12月河北医科大学第四医院收治的结直肠癌患者354例为研究对象，收集患者临床特征资料。以手术日期或病理确诊日期为随访起点对患者或家属进行随访，以肿瘤复发、转移及死亡为终点事件，随访时间截至2014-01-01，无进展生存期（ PFS）定义为从确诊至肿瘤复发、转移或死亡的时间。结果直乙肠交界处癌、直肠癌和乙状结肠癌患者年龄、初始治疗方式、肿瘤最长径及浸润深度比较，差异有统计学意义（χ2＝0.009、0.015、0.019、0.005， P＜0.05）。354例患者失访17例，失访率为4.8％；随访时间3～91个月，中位随访时间为44个月。直乙肠交界处癌中位生存时间为64.0个月〔95％CI （47.5，80.5）〕，1、2、3年生存率分别为93.6％、85.3％和76.2％；直肠癌中位生存时间为63.0个月〔95％CI （53.2，72.8）〕，1、2、3年生存率分别为93.4％、85.5％和76.3％；乙状结肠癌中位生存时间为63.0个月〔95％CI （51.2，74.8）〕，1、2、3年生存率分别为94.5％、87.2％和79.3％。直乙肠交界处癌、直肠癌和乙状结肠癌患者生存曲线比较，差异无统计学意义（χ2＝1.246， P＝0.536）。直乙肠交界处癌、直肠癌和乙状结肠癌中位 PFS 分别为48.0个月〔95％CI （36.3，59.7）〕、29.0个月〔95％CI （17.9，40.1）〕和63.0个月〔95％CI （37.1，88.9）〕。直乙肠交界处癌、直肠癌和乙状结肠癌PFS的生存曲线比较，差异有统计学意义（χ2＝17.329， P＝0.001）。 Cox比例风险回归分析结果显示，肿瘤部位〔HR＝0.585，95％CI （0.338，0.891）， P＝0.012〕及浸润深度〔HR＝3.516，95％CI （1.883，6.746）， P＝0.038〕是影响结直肠癌患者PFS的独立预测因素。结论直乙肠交界处癌与直肠癌、乙状结肠癌生存时间未见不同，而PFS存在差异，肿瘤浸润深度可能为结直肠癌患者PFS的影响因素。

Objective To investigate the differences in the prognosis of recto -sigmoid cancer , rectal cancer and sigmoid cancer and the influencing factors .Methods We enrolled 354 patients with colorectal cancer in the Fourth Hospital of Hebei Medical University from January 2008 to December 2012.We collected the data of clinical features of the patients .From the day of surgery or pathological diagnosis , we conducted follow -up visits to patients and their families , and neoplasm recurrence , metastasis and death were considered as the outcome events respectively .PFS was defined as the time from diagnosis to the neoplasm recurrence , metastasis or death .All follow-up visits were ceased on January 1, 2014.Results Patients with the three kinds of neoplasms were significantly different in age , initial treatment method , the longest diameter of the tumor and the depth of infiltration （χ2 =0.009, 0.015, 0.019, 0.005; P〈0.05）.Of the 354 patients, we lost 17 patients with a loss rate of 4.8%;the follow-up time was 3 to 91 months, and the median follow -up time was 44 months.For the patients with recto-sigmoid cancer, the median survival time was 64.0 months 〔95%CI （47.5, 80.5）〕, and the survival rates of one year , two years and three years were 93.6%, 85.3%and 76.2%; for the patients with rectal cancer , the median survival time was 63.0 months 〔95%CI （53.2, 72.8）〕, and the survival rates of one year , two years and three years were 93.4%, 85.5%and 76.3%; for patients with sigmoid cancer , the median survival time was 63.0 months 〔95%CI （51.2, 74.8）〕,nbsp;and the survival rates of one year , two years and three years were 94.5%, 87.2%and 79.3%.Patients with the three kinds of neoplasm were not significantly different in the survival curve （χ2 =1.246, P=0.536）.The median PFS for patients with recto-sigmoid neoplasm, rectal neoplasm and sigmoid neoplasm was 48.0 months 〔95%CI （36.3, 59.7）〕, 29.0 months 〔95%CI （17.9, 40.1）〕 and 63.0 months 〔95%CI （37.1, 88.9）〕 respectively.Patients with the three kinds of neoplasm were significantly different in PFS survival curve （χ2 =17.329, P=0.001）.Cox regression analysis showed that the neoplasm site〔HR=0.585, 95%CI （0.338, 0.891）, P=0.012〕 and depth of infiltration 〔HR=3.516, 95%CI （1.883, 6.746）, P=0.038〕 were independent predictive factors for PFS of patients with colorectal cancer .Conclusion There are no differences in survival time among patients with recto -sigmoid neoplasm , rectal neoplasm and sigmoid neoplasm , while differences exist in PFS.The depth of infiltration may be the influencing factor for PFS of patients with colorectal cancer .