cT4bM0结直肠癌患者的临床病理特征及两种手术方式疗效比较

Clinicopathological features of patients with cT4bM0 colorectal cancer and comparison of the therapeutic effects of two different surgical methods

目的:研究临床T分期(cT)4bM0结直肠癌患者的临床病理特征,并比较两种不同手术方式的疗效差异。方法:回顾性分析2017年4月至2022年6月江苏省中医院消化系肿瘤外科收治的60例cT4bM0结直肠癌患者的临床资料。其中,Hartmann术30例,Dixon术30例。分析其临床病理特征,并比较两组患者无复发生存率(RFS)、总生存率(OS)等指标。采用电话、门诊、短信等方式对患者进行随访,随访截止时间2023年6月。结果:本研究收集的60例cT4bM0结直肠癌患者均达到R0切除,其中术后病理T分期(pT)4b所占比例为18.33%(11/60),pN0所占比例为75.0%(45/60),pTNMⅠ~ⅡA期所占比例为61.67%(37/60)。对比Hartmann组、Dixon组患者年龄、性别、pTNM分期、pT分期、pN分期及2年RFS、OS,差异无统计学意义(均P>0.05)。pT_(4b)与pT_(2)~T_(4a)患者相比,pT_(4b)患者更易发生淋巴结转移(P<0.05),两组患者的2年RFS、OS差异无统计学意义(均P>0.05)。结论:cT4bM0结直肠癌患者,临床T分期与病理T分期常存在偏倚,对其手术治疗,R0切除为关键,Hartmann术与Dixon术疗效无明显差异,临床上可优先考虑Dixon术。

Objective:To explore the clinicopathological features of patients with clinical T stage(cT)4bM0 colorectal cancer and compare the therapeutic effects of two different surgical methods.Methods:The clinical data of 60 patients with cT4bM0 colorectal cancer who were admitted to the Jiangsu Province Hospital of Chinese Medicine from April 2017 to June 2022 were retrospectively analyzed.These patients were divided into two groups based on different surgical methods:Hartmann group(n=30)and Dixon group(n=30).The clinicopathological features and the patients'recurrence free survival(RFS)and overall survival(OS)were analyzed.The patients were followed up via phone call,out-patient examination or text message,and the deadline of follow-up was June 2023.Results:R0 resection was achieved for all 60patients with cT4bM0 colorectal cancer.The proportion of pT4b,pN0 and pTNMⅠ~ⅡA was 18.33%(11/60),75.0%(45/60)and 61.67%(37/60)respectively.There was no statistically significant difference in age,gender,pTNM,pT,pN,the patients'2-year RFS and OS between the Hartmann and Dixon groups(P>0.05).Compared with patients in stage pT2-T4a,patients in stage pT4b are more prone to lymph node metastasis(P<0.05),but there was no statistically significant difference in the patients'2-year RFS and OS(P>0.05).Conclusion:Bias usually exists between clinical T stage and pathological T stage for patients with cT4bM0 colorectal cancer.R0 resection is the key to their surgical treatment,and there is no significant difference in therapeutic effects between Hartmann and Dixon.Dixon should be given priority in clinical practice for these patients.