结直肠癌原发肿瘤部位对术后患者生存的影响

Association of primary tumor location with prognosis in postoperative colorectal cancer patients

目的探讨大肠癌原发肿瘤部位与临床病理特征的关系,以及原发肿瘤部位对生存的影响。方法纳入2000年9月至2016年4月就诊于中国医科大学附属第一医院肿瘤内科的I^III期根治性切除术后大肠癌患者,分析大肠癌原发肿瘤部位与临床病理特征的关系,以及对预后的影响。结果 1 345例大肠癌患者根据原发肿瘤部位不同,分为直肠、左半结肠、右半结肠3组。结果显示,原发肿瘤部位与性别(χ2=10.943;P=0.004)、组织学分级(χ2=12.402;P=0.015)、病理T分期(χ2=49.794;P<0.001)、TNM分期(χ2=30.102;P<0.001)显著相关。生存分析结果显示,3组间的生存时间差异未见明显统计学意义(χ2=4.806;P=0.09)。单因素分析发现,原发肿瘤位置与预后未见显著相关性(χ2=2.938;P=0.088),而淋巴结转移数目(χ2=39.739)及TNM分期(χ2=23.872)与预后显著相关,P值均<0.001;多因素分析结果显示,仅淋巴结转移数目与预后显著相关(95%CI:1.210~2.317;P=0.002)。结论根治性切除术后结直肠癌的原发肿瘤部位不同,其临床病理特征有所不同。原发肿瘤部位与预后未见显著相关性,仅淋巴结转移数目可作为独立预后因素。

Objective To investigate the association of primary tumor location with clinical pathologic features and prognosis in postoperative colorectal cancer patients. Methods Patients with stage I～III colorectal cancer treated in the First Hospital of China Medical University from September 2000 to April 2016 were collected, and the relationship between primary tumor location and clinical pathological features was analyzed. The effect of primary tumor location on the prognosis was also investigated. ResultsIn total, 1 345 patients with colorectal cancer were grouped according to primary tumor location： the rectum, left-sided, and right-sided colon group. The primary tumor location was associated with gender（（χ^2=10.943; P=0.004）, histological grade（χ^2=12.402; P=0.015）, pathological T stage（χ^2=49.794; P〈0.001） and TNM stage（χ^2=30.102; P〈0.001）. Survival analysis showed no significant difference in three groups（χ^2=4.806; P=0.09）. Cox univariate analysis did not show any correlation between primary tumor location and survival（χ^2=2.938; P=0.088）, but showed a significant correlation between positive lymph nodes、TNM stage and prognosis（χ^2=39.739, χ^2=23.872; P〈0.001）. Multivariable analyses showed a significant correlation between positive lymph nodes and survival（95%CI： 1.210～2.317; P=0.002）. Conclusion In postoperative colorectal cancer, different primary tumor location correlated with different clinical pathological characteristics. There was no relationship between primary tumor location and prognosis. Number of positive lymph nodes was an independent prognostic factor for survival.