直肠癌手术下切缘阳性的危险因素及预后分析

Analysis of risk factors and prognosis for positive distal surgical margins of rectal cancer

目的:探讨分析直肠癌患者行保肛手术出现下切缘阳性的危险因素及预后。方法:筛选2016年1月-2020年12月在我院行直肠癌手术患者283例,病理示下切缘阳性再行R0切除患者21例作为观察组,262例直接达R0切除患者为对照组。回顾性分析两组患者临床病例资料并随访。结果:BMI(OR=4.325,95%CI:1.633~11.457,P=0.003)、新辅助治疗(OR=2.819,95%CI:1.062~7.484,P=0.038)、肿瘤距肛缘距离(OR=3.201,95%CI:1.200~8.538,P=0.020)为术中出现下切缘阳性的独立危险因素。观察组3年无瘤生存率为47.6%显著低于对照组的71.4%(P=0.023)。两组间1年无瘤生存率、1年总生存率以及3年总生存率比较,差异无统计学意义(P>0.05)。结论:BMI、新辅助治疗、肿瘤距肛缘距离是影响直肠癌标本下切缘阳性的独立危险因素。出现下切缘阳性的直肠癌患者即使再行根治手术预后仍较差。

Objective:To evaluate risk factors and prognosis of the patients undergoing sphincter-preserving surgery in case of low rectal adenocarcinoma with positive distal surgical margins.Methods:We retrospectively studied 283 rectal cancer patients who underwent radical surgery at our hospital from January 2016 to December 2020.21 patients performed final R0 resection with positive distal surgical margins were assigned to the observation group and 262 patients with direct resection up to R0 were in the control group.Clinical data including follow-up were collected and analyzed.Results:BMI(OR=4.325,95%CI:1.633~11.457,P=0.003),neoadjuvant therapy(OR=2.819,95%CI:1.062~7.484,P=0.038),tumor distance from the anal margin(OR=3.201,95%CI:1.200~8.538,P=0.020)were independent risk factors of rectal cancer patients with positive distal surgical margins.The 3-year tumor-free survival of the observation group(47.6%)was significantly lower than that of the control group(71.4%)(P=0.023).1-year tumor-free survival rate and 1-year,3-year overall survival rate were not statistically different between the two groups(P>0.05).Conclusion:BMI,neoadjuvant therapy,and tumor distance from the anal margin were independent risk factors for rectal cancer patients with positive distal surgical margins.And patients who had intraoperatively positive distal surgical margins underwent an additional radical surgery still had a poor prognosis.