早期结直肠癌局部切除与根治性术后生存比较

Survival after local excision or radical resection for earlystage colorectal cancer

目的:研究早期结直肠癌局部切除术与根治性术后患者生存期的差异.方法:回顾性分析1998/2008年SEER数据库中符合筛选条件的患者,根据手术方式分为局部切除组和根治性手术组,并根据肿瘤部位分为结肠癌亚组和直肠癌亚组,通过绘制Kaplan-Meier生存曲线,比较两组患者的生存期差异及独立预后因素.结果:本研究共入组13795例患者,根治性切除的共13647例,其中结肠癌10389例,直肠癌3258例;局部切除的共148例,其中结肠癌62例,直肠癌86例.T1期更倾向于接受局部切除,而T2期则更倾向于接受根治性切除(P<0.001).单因素生存分析结果显示:T1期结肠癌根治性手术组与局切手术组患者的5年和10年生存率有统计学差异(P=0.0069);T2期两组并无统计学差异(P=0.278).T1和T2期直肠癌根治性手术组与局切手术组患者的5年和10年生存率均无统计学差异(P=0.253,0.975).多生存因素分析结果显示:性别、年龄、种族、肿瘤大小、肿瘤分化程度和手术方式是影响预后的独立因素,但结直肠癌有各自的特点.结论:对于T1、T2期直肠癌,行局部切除可以达到根治性手术的效果,获得同等的生存率;T1期结肠癌,根治性切除比局部切除能获得更好的生存率;T2期结肠癌有待增加样本量后进一步对比分析.

AIM： To compare the overall survival after local excision or radical resection for earlystage colorectal cancer. METHODS： Patients who met the criteria were screened from the SEER database between 1998 and 2008, and they were divided into a local excision group and a radical resection group according to the mode of surgery. Each group was further divided into colon or rectal cancer subgroup according to the location of tumor. Kaplan-Meier analysis was performed to determine the overall survival between the two groups and independent prognostic factors. RESULTS： A total of 13975 cases were included in the study. Of 13647 cases receiving radical resection, 10389 had colon cancer and 3258 had rectal cancer. Of 148 cases receiving local excision, 62 had colon cancer and 86 had rectal cancer. Tumors at T1 stage tended to receive local excision, while tumors at T2 stage were more inclined to accept radical resection（P〈0.001）. Univariate survival analysis showed that there were statistical differences between the two groups in 5-year and 10-year survival rates of patients with stage T1 colon cancer, althougn no significant differences were noted in patients with stage T2 colon cancer and those with both stages T1 and T2 rectal cancer. Multivariate survival factor analysis showed that gender, age, race, tumor size, tumor differentiation and mode of surgery were independent prognostic factors, but both colon cancer and rectal cancer had their own characteristics. CONCLUSION： Local excision can obtain the same survival rate as radical surgery in patients with stages T1 and T2 rectal cancer. Compared to local excision, radical resection can offer better overall survival in patients with stage T1 colon cancer, while more cases are needed to analyze the difference in patients with stage T2 colon cancer.