摘要
目的研究直肠神经内分泌肿瘤（NET）的临床病理因素与淋巴结转移及预后的关系，探讨手术方式的选择。方法收集48例直肠NET切除术后患者的临床病理资料。分别采用卡方检验和Logistic回归法进行肿瘤临床病理因素与淋巴结转移关系的单因素和多因素分析。采用Kaplan-Meier方法进行预后单因素生存分析，以Log—rank检验进行生存率比较，采用Cox模型进行预后多因素生存分析。结果单因素分析显示，与淋巴结转移相关的临床病理因素为肿瘤距肛缘≤6cm、肿瘤最大径〉2cm、有肌层浸润、有远处转移、组织学3级。多因素分析显示，组织学3级是淋巴结转移的独立相关因素[比值比（0l尺）一9．333，95％可信区间（CI）：1．054～82．635，P一0．045]。单因素生存分析显示，预后差的相关因素为肿瘤距肛缘≤6cm、肿瘤最大径〉2cm、有肌层浸润、有淋巴结转移、有远处转移、组织学3级。多因素生存分析显示，肿瘤距肛缘≤6cmE风险比（HR）=0．215，95％CI：0．047～0．980，P=0．047]、有远处转移（HR=8．788，95％CI：2．612～29．571，P〈0．01）、组织学3级（HR=5．510，95％CI：1．692-17．944，P=0．005）是预后差的独立相关因素。结论在无远处转移的情况下，对于组织学1级和2级的直肠NET患者，若肿瘤最大径〉2cm或有肌层浸润，推荐其接受根治性手术；在无远处转移的情况下，组织学3级的直肠NET患者均推荐其接受根治性手术。
Objective To study the correlation between clinicopathological characteristics and lymph node metastasis and prognosis of rectal neuroendocrine tumors （NET）, and try to explore the choice of surgical approach. Methods The clinicopathological data of 48 postoperative rectal NET patients were collected. The univariate and multivariate analysis of the correlation between clinicopathologic characteristics and lymph node metastasis were performed by chi-square test and Logistic regression. The prognosis single factor survival analysis was analyzed by Kaplan-Meier method. The survival rates were compared by Log-rank test. The prognosis multivariate survival analysis was performed by the use of Cox model. Results The results of univariate analysis indicated that clinicopathological characteristics related with lymph node metastasis were tumor distance from anal verge less than six cm, tumor diameter over two cm, muscularis invasion, distant metastasis and histological grade 3. The results of multivariate analysis showed that histological grade 3 was an independent risk factor of lymph node metastasis （OR= 9. 333, 95 %/00CI： 1. 054 to 82. 635, P= 0. 045）. The results of univariate survival analysis suggested that factors correlated with poor prognosis were tumor distance from anal verge less than six cm, tumor diameter over two cm, muscularis invasion, lymph node metastasis, distant metastasis and histological grade 3. The results of multivariate survival analysis indicated that tumor distance from anal verge less than six cm （HR-= O. 215, 95%CI：O. 047 to 0.980, P=0.047）, distant metastasis （HR=8.788, 95%CI： 2. 612 to 29. 571, P%0.01） and histological grade 3 （HR=5. 510, 95%CI： 1. 692--17. 944, P=0. 005） were independent factors associated with poor prognosis. Conclmions For histological grade 1 and 2 rectal NET patients without distant metastasis, radical surgery is recommended when tumor diameter over two cm or muscularis invasion exists. For histological grade 3 rectal NET patients without
出处
《中华消化杂志》
CAS
CSCD
北大核心
2012年第12期826-829,共4页
Chinese Journal of Digestion
关键词
直肠肿瘤
神经内分泌肿瘤
淋巴转移
预后
Rectal neoplasms
Neuroendocrine tumors
Lymphatic metastasis
Prognosis
