左右半结直肠癌临床病理特征及预后分析

Clinicopathological Features and Prognosis of Left-sidedand Right-sided Colorectal Cancer

目的探讨原发肿瘤部位对结直肠癌(CRC)患者临床病理特征及预后的影响。方法回顾性分析郑州大学第一附属医院382例CRC患者的临床病理及生存资料,以脾曲为界,分为右半(141例)和左半(241例)结直肠癌,比较两组患者临床病理特征及预后差异,采用Kaplan-Meier法绘制生存曲线,采用Log-rank检验比较生存差异,采用Cox回归分析CRC术后患者死亡的危险因素。结果左右半结直肠癌在术前肠梗阻、是否合并糖尿病、胆囊疾病、家族史、血红蛋白(Hb)水平、肿瘤长径、组织类型、分化程度、浸润深度、远处转移及病理分期方面差异有统计学意义(P<0.05)。Cox回归分析显示:术前癌胚抗原(CEA)水平、肿瘤部位、肿瘤长径、淋巴结转移、远处转移及术后复发是影响CRC患者术后总生存期(OS)的独立危险因素(P<0.05);右半结肠癌(RCC)术后OS短于左半结直肠癌(LCRC)患者(59.2个月比66.2个月,χ2=8.176,P=0.004)。结论与LCRC相比,RCC患者更容易合并胆囊疾病、糖尿病及肿瘤家族史,术前易出现肠梗阻及贫血症状,肿瘤长径更大,更容易出现黏液腺癌成分,分化程度更低,浸润更深,更容易出现远处转移,病理分期晚,OS更短。

Objective To investigate the effect of primary tumor location on clinicopathological features and prognosis of colorectal cancer(CRC)patients.Methods A total of 382 patients with CRC who underwent surgery in the First Affiliated Hospital of Zhengzhou University were enrolled in this study.There were 141 and 241 cases classified as right-sided colorectal cancer(RCC)and left-sided colorectal cancer(LCRC)by splenic curvature.The clinicopathological features and prognosis among the two groups were compared.Kaplan-Meier method and Log-rank test were used to plot and compare the survival curve.Cox regression analysis was used to investigate the influencing factors of death.Results There were statistically difference in preoperative intestinal obstruction,comorbidities such as diabetes and gallbladder diseases,family history of malignant tumor,the level of hemoglobin(Hb),tumor diameter,histopathological type,differentiation degree,the depth of invasion,distant metastasis,and pathological stages among RCC and LCRC(P<0.05).Multivariate Cox regression analysis showed that preoperative level of carcinoembryonic antigen(CEA),primary tumor location,tumor diameter,lymph node metastasis,distant metastasis and postoperative recurrence were independent risk factors affecting the overall survival(OS)of CRC patients(P<0.05).OS was worse in RCC than LCRC(59.2 months versus 66.2 months,χ2=8.176,P=0.004).Conclusion Compared to LCRC,RCC tends to accompany with diabetes and gallbladder diseases,family history of malignant tumor,preoperative intestinal obstruction and anemia.Moreover,RCC has longer tumor diameter,more mucinous adenocarcinoma,poor differentiation,deeper invasive depth,more distant metastasis,advanced pathological stages and shorter OS than LCRC.