结直肠癌术后复发的危险因素和不同年龄患者病理特点研究

Analysis of the pathological characteristics and risk factors of postoperative recurrence of patients with colorectal carcinoma at different age

目的探讨不同年龄结直肠癌(CRC)患者的病理特点与影响其术后复发的相关危险因素。方法回顾性分析158例CRC患者临床资料,根据国际年龄划分标准将其分成青年组(A组)17例、中年组(B组)60例、老年组(C组)81例,回顾性分析其病理特征差异;此次入组的158例患者均行结直肠癌根治术,行术后为期2年随访,根据其随访期内复发情况分成复发组27例和非复发组131例,回顾性分析其一般资料差异,对单因素分析后存在显著性差异的指标行非条件Logistic回归分析。结果 1此次受试的158例CRC受试者中,A、B、C患者所占比例分别为51.3%、38.0%和10.7%;三组患者在组织学类型及肝转移率对比上均无统计学意义(P>0.05);A组以TNM分期为Ⅲ期、肿瘤直径<6 cm、病灶位于远端结肠者居多,B、C组患者则以TNM分期为Ⅰ、Ⅱ期、肿瘤直径≥6 cm、病灶位于近端结肠或直肠者居多,差异具有统计学意义(P<0.05);2淋巴结转移、TNM分期、术后辅助化疗等为影响CRC患者术后复发的单因素(P<0.05);3淋巴结转移及TNM分期与术后复发呈正相关性,术后辅助化疗则与术后复发呈负相关性(P<0.05)。结论不同年龄CRC患者在肿瘤直径、TNM分期、肿瘤位置等病理特征上存在明显差异;淋巴结转移及TNM分期是结直肠癌根治术后复发的独立危险因素,需引起临床重视。

Objective To investigate the pathological characteristics and the related risk factors that affecting the postoperative recurrence of patients with colorectal carcinoma（CRC） at different age. Methods The clinical data of 158 patients with CRC were retrospectively analyzed. According to the international age classification standard, the patients were divided into the young group（n =17）, the middle-aged group n =60） and the elderly group（n=81） of three groups. The differences in pathological characteristics were retrospectively analyzed. All the 158 cases were given radical resection of colorectal carcinoma and after operation, there was 2 yeas of follow-up.According to the condition of recurrence during follow-up, the patients were divided into the recurrence group（n=27） and the non recurrence group（n=131） of two groups. The differences in general data were retrospectively analyzed. Indexes with significant differences after single factor analysis were studied by unconditioned Logistic regression analysis. Results 1Among the 158 cases of CRC subjects, the aged, middle-aged and young patients accounted for51.3%、38.0% and 10.7%, respectively. The comparisons of histological patterns and liver metastasis rates among the three groups were not statistically significant（P 〉 0.05）. In group A, patients who were at stageⅢ of TNM staging and whose tumor diameter was less than 6cm and lesions were located in the distal colon were the majority while in group B and group C, patients who were at stageⅠandⅡ of TNM staging and whose tumor diameter was more than or equal to 6 cm and whose lesions located in the proximal colon or rectal were the majority. The difference was statistically significant（P 〈 0.05）. 2 Lymph node metastasis, TNM staging and postoperative adjuvant chemotherapy, etc. were the single factors that affecting postoperative recurrence of patients with CRC（P〈0.05）. 3Lymph node metastasis and TNM staging were positively correlated with postoperative recurrence while postoperative adjuvant chemotherapy was negatively correlated with postoperative recurrence（P 〈0.05）. Conclusion There are significant differences in tumor diameter,TNM staging, tumor location and other pathological characteristics of CRC patients at different ages. Lymph node metastasis and TNM staging are independent risk factors of recurrence after radical resection of colorectal carcinoma, which needs clinical attention.