基于单中心大样本的不同手术日对结直肠癌患者预后影响的回顾性研究

Can the weekday of surgery influence the prognosis of colorectal cancer patients？ A retrospective study based on a single-center of large sample

目的探讨不同手术日对结直肠癌患者预后生存的影响。方法对复旦大学附属肿瘤医院2007年1月至2013年12月期间行根治性手术治疗的4971例结直肠癌患者的病例资料进行回顾性研究。将星期一至星期四施行手术的患者记为“周一至四手术组”．星期五施行手术的患者记为“周五手术组”；对两组患者的手术情况及术后随访情况进行分析，应用X^2检验比较分类变量，t检验比较连续变量组间差异，Kaplan-Meier法绘制生存曲线，Log—rank法比较组问生存率的差异。结果周一至四手术组和周五手术组患者年龄、性别和肿瘤病理学分期等方面差异没有统计学意义（P〉0．05）。周一至四手术组术中淋巴结清扫数目（中位数16枚）显著高于周五手术组（中位数14枚），差异有统计学意义（P=0．038）。全组5年总体生存率和无疾病生存率分别为78．0％和55．0％。周一至四手术组5年总体生存率为79．6％，周五手术组为77．2％，两组差异无统计学意义（P=0．882）；无疾病生存率两组分别为57_8％和50．4％，差异仍无统计学意义（P=0．210）。进一步根据病理分期进行亚组分析显示，周一至四手术组和周五手术组Ⅰ期患者5年总体生存率分别为94．7％和90．6％（p=0．742），无疾病生存率分别为85．1％和78．2％（P=0．765）；Ⅱ期患者5年总体生存率分别为85．5％和83．7％（P=0．496），无疾病生存率分别为72．7％和62．8％（P=0．121）：Ⅲ期患者5年总体生存率分别为69．7％和69．4％（P=0．354），无疾病生存率分别为41.8％和37．4％（P=0．976）；差异均无统计学意义。结论星期一至星期四施行手术与星期五施行手术，结直肠癌患者的远期生存相当。

Objective To investigate the impact of the weekday of surgery on the prognosis of patients with colorectal cancer. Methods A retrospective analysis was conducted＇ in patients with colorectal cancer who underwent radical resection in Fudan University Shanghai Cancer Center（FUSCC） between January 2007 and December 2013, and 4 971 patients were identified eligible. Statistical analyses were carried out between patients who received surgery on Monday to Thursday and those who received surgery on Friday. Chi-square test was used to analyze the relationship between clinicopathological parameters and day of surgery. T test was used to compare continuous variables between groups, The 5-year overall survival （OS） and disease-free survival （DFS） were calculated by the Kaplan-Meier method, and compared by log-rank test. Results There were no statistically significant differences between two groups in age, gender and pathological grade et al （all P 〉 0.05）. However, the number of dissected lymph node was higher in patients who received surgery on Monday to Thursday （median 16） compared with patients who received surgery on Friday （median 14）, with statistically significant difference （P = 0.038）. The 5-year OS and DFS in all eligible patients were 78.0% and 55.0%, respectively. 5-year OS of patients in Monday to Thursday surgery group and Friday surgery group was 79.6% and 77.2%, while 5-year DFS in two groups was 57.8% and 50.4%. There were no significant differences in OS and DFS between two group, with P = 0.882 and P = 0.210, respectively. Subgroup analyses were conducted according to different pathological stages. 5-year OS of patients at stage I in Monday to Thursday surgery group and Friday surgery group was 94.7% and 90.6% （P = 0.742） and 5-year DFS was 85.1% and 78.2% （P = 0.765）. 5-year OS of patients at stage I1 in two groups was 85.5% and 83.7% （P = 0.496） and 5-year DFS was 72.7% and 62.8% （P = 0.121）. 5- year OS of patients at stage Ⅲ in two groups was 69.7% and 69.4%（P = 0.354） and 5-year DFS was 41.8% and 37.4% （P = 0.976）. No statistically significant differences manifested in subgroup analyses. Conclusion Patients with colorectal cancer undergoing surgery on Monday to Thursday have similar long-term prognosis with those on Friday.