摘要
目的探讨直肠癌的病期、病理、辅助治疗方法等对预后的影响。方法搜集1994年1月至1999年10月间在广东省茂名市人民医院治疗的163例直肠癌患者的临床资料。男88例，女75例。年龄19—85岁，中位年龄56岁。根据UICC1997年制定的分期标准，Ⅰ期23例，Ⅱ期60例，Ⅲ期75例，Ⅳ期5例。腹、会阴联合直肠切除术（Miles术）85例，经腹直肠切除吻合术（Dixon术）68例，经腹直肠切除、结肠造瘘术（Hartmman术）7例，其他3例。根治手术159例，占97．5％；其余4例为姑息性手术。123例手术后2周至4个月接受术后放射治疗，剂量范围32—62Gy，中位剂量50Gy。随访5—105个月，中位随访时间65个月。采用SPSS10．0统计软件，生存率用Kaplan-Meier方法计算，相关因素等对生存期的影响用Log-rank方法检验。结果全组1，3，5年总生存率分别为93．3％、72．4％和60．7％。Ⅰ、Ⅱ、Ⅲ和Ⅳ期的5年生存率分别为87．4％、75．1％、45．4％和0。TNM分期、病理类型、分化程度与预后有相关性。肿瘤部位、术式、年龄、是否接受术后放射治疗与生存率无明显相关性。总复发率为17．2％。最易出现局部复发的部位是骶前区，其次是髂内血管旁，总转移率为32．5％。远地血行转移中，肝脏、肺、骨和脑部转移率分别居第1、2、3和4位。T和N分期晚、黏液腺癌、印戒细胞癌、低分化癌复发转移率高。结论TNM分期、病理类型、分化程度是决定预后的主要因素；直肠癌术后最易出现区域复发的部位是骶前区和髂内血管旁；最易远地转移的部位是肝和肺。
Objective To study how the TNM stage, pathologic classification and adjuvant treatment influence the prognosis of rectal cancer. Methods From January 1996 to October 1999, 163 patients （ male 88 ,female 75） with rectal cancer （ by 1997 UICC stage system ： stage Ⅰ 23, stage Ⅱ 60, stage Ⅲ 75 and stage Ⅳ 4）were treated with surgery including Miles operation 85, Dixon operation 68, Hartmman operation 7 and other ways of surgery 3. Of all patients, 159 underwent radical resection and 4 palliative operation. 123 cases received postoperative radiotherapy with a median dose of 50 Gy. Follow-up time ranged from 5 to 105 months with a median of 65. Results The overall survival rates at 1, 3 and 5 years were 93.3%, 72.4% and 60.7% ,respectively. The overall 5-year survival rates were 87.4% ,75.1% ,45.4% and 0 for stage Ⅰ , stage Ⅱ, stage Ⅲ and stage Ⅳ, respectively. TNM stage, pathologic classification and histological grade were significant prognostic factors. Location of tumor, ways of surgery, age and postoperative radio- therapy or surgery alone did not affect the survival rate. The overall rate of recurrence after resection was 17.2% and recurrence occurring in presacral region was the most common pattern of local failure. Internal iliac lymph nodes were the second region at risk of relapse. The overall rate of distant metastasis was 32.5% and the liver, lung, bone and brain ranked the first, second, third and fourth frequency of distant metastasis of rectal cancer. Advanced T and N stage, mucinous adenocarcinoma, signet ring cell carcinoma and poorly differentiated carcinoma had higher rate of recurrence and metastasis as well as lower survival rate compared with early T, N stage and well differentiated tumors. Conclusions The TNM stage, pathologic classification and histologic＇,d grade are significant prognostic factors of rectal cancer. Recurrence in presaeral region is the most common pattern of local failure and internal iliac lymph nodes the second. The main sites of metastasis are liv
出处
《中国肿瘤临床与康复》
2006年第1期29-31,共3页
Chinese Journal of Clinical Oncology and Rehabilitation
关键词
结直肠肿瘤
TNM分期
病理类型
预后
Colorectal neoplasms
TNM stage
Pathologic classification
Prognosis
