结直肠癌患者癌结节分期方法的初步研究

Initial research on staging method of tumor deposits in CRC patients

目的寻找更恰当的癌结节分期方法。方法采用回顾性分析方法,收集2007年3月1日至2009年12月31日云南省肿瘤医院(昆明医科大学第三附属医院)大肠癌科收治的经病理学证实并行肠癌根治手术的原发性结直肠癌患者的临床资料和生存资料,进行统计分析。结果淋巴结转移患者在癌结节阳性时的预后明显差于无癌结节患者(51.3%vs 74.9%,P=0.007)。多因素分析发现癌结节、术后辅助化疗是影响淋巴结转移结直肠癌患者总生存期的独立危险因素(P<0.05);将癌结节纳入淋巴结转移计数后形成新n N分期和TNM分期(n N)中各分期有明显的预后差异(P<0.05)。多因素分析发现TNM分期(n N)仍是结直肠癌患者的预后影响因素,而第七版TNM分期已不是;将癌结节阳性患者按照癌结节检出1个、2个、3个为临界值分别分为两组,并比较两组患者的预后差异,结果只有按癌结节(tumor deposits,TD)=1来分组两组具有显著的预后差异(31.2%vs 61%,P=0.018)。结论在淋巴结转移患者中第七版癌结节分期方法并不恰当,将癌结节纳入转移淋巴结计数形成的TNM分期评估预后的价值优于七版TNM分期标准,且较七版TNM分期标准更简化。

Objective To find a more appropriate staging method of tumor deposits. Methods Weretrospectively evaluated patients with CRC, who underwent radical resection from March 1, 2007 toDecember 31, 2009 in Yunnan Province Cancer Hospital, data were collected retrospectively for statisticalanalysis. Results The prognosis of patients with TD were significantly worse than that of patients withoutTD in LNM patients (51.3% vs 74.9%, P=0.007). Multivariate Cox regression model analysis found that TDand postoperative adjuvant chemotherapy are independent risk factors for overall survival in LNM patients(P < 0.05); TD which counted as positive lymph nodes with the new N staging system has better prognosticvalue for patients in each TNM stage (P < 0.05). Multivariate analysis showed that TNM stage (nN) is stilla prognosis factors, but the 7th edition of TNM stage system is not; The patients with TD were divided intotwo groups by the number of TD, and the prognosis was compared between two groups, results showedthat only the group divided by TD=1 has significant difference in prognosis (31.2% vs 61%, P=0.018).Conclusions The staging method of tumor deposits in 7th edition TNM staging system is not appropriate forpatients with lymph node metastasis. The prognostic value of a new TNM staging that counted TD as positivelymph nodes is better than 7th edition of TNM staging system, and the TNM staging system is simplified.