摘要
目的分析直肠癌根治术后的复发类型与预后的关系，建立直肠癌复发模式的分类。
方法连续纳入2008—2012年入中山大学附属第六医院结直肠外科，行根治性手术后复发的463例Ⅰ～Ⅲ期直肠癌患者，从是否复发、复发时间、复发位置、复发后生存时间、可根治性、有无症状、癌胚抗原（CEA）是否升高等方面记录复发的数据资料，回顾性分析它们与预后的关系，Kaplan－Meier法绘制生存曲线，Log－rank法检验显著性，单因素分析采用Cox比例风险模型分析。
结果 1年内复发、多发转移、有症状、CEA升高和不可切除复发的生存率分别低于1年后复发、单发转移、无症状和CEA正常和可切除复发，风险比分别为1.34（95%CI 1.02～1.76，P＝0.033）、1.41（95%CI 1.04～1.91，P＝0.026）、1.74（95%CI 1.05～2.88，P＝0.032）、4.06（95%CI 2.11～7.85，P〈0.001）和1.99（95%CI 1.34～2.97，P＝0.001）。
结论早期复发（12个月内）、多发转移、有症状、不可切除复发和CEA升高的复发均提示复发后预后不良，我们的研究系统地提供了对直肠癌根治术后复发模式进行分类的依据。
ObjectiveTo establish the classification of colorectal cancer recurrence patterns based on their relations to prognosis and recurrence.
MethodsA total of 463 patients with recurrent rectal cancer （Stage Ⅰ-Ⅲ） following curative resection in our hospital from June 2002 to June 2012 were included consecutively. Recurrence status, time, location, survival time after relapse, curability, symptoms and CEA level were recorded. The correlation between each recurrent pattern and recurrent survival （RS） rate were analyzed retrospectively. The survival curve was drawn by Kaplan-Meier method. The Log-rank test was used to test the significance. Univariate analysis was performed by using Cox proportional hazard model.
ResultsPatients with recurrence within one year, multiple metastases, symptomatic disease, elevated CEA level and unresectable recurrence had significantly lower RS rate than patients with recurrence after one year, solitary metastasis, asymptomatic manifestation, normal CEA level and resectable recurrence respectively. The hazard ratio were 1.34 （95%CI 1.02-1.76, P= 0.033）, 1.41 （95%CI 1.04-1.91, P= 0.026）, 1.74 （95%CI 1.05-2.88, P= 0.032）, 4.06 （95%CI 2.11-7.85, P〈0.001） and 1.99 （95%CI 1.34-2.97, P= 0.001） respectively.
ConclusionEarly recurrence （〈12 months）, multiple metastases, symptomatic, unresectable recurrence and elevated CEA indicate poor prognosis after relapse. This study provides a systematic basis for the classification of recurrence in colorectal cancer after radical resection.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2016年第8期625-628,共4页
National Medical Journal of China
基金
基金项目：国家重点基础研究发展计划（973）项目（2015CB554001,JW）
国家自然科学基金（81472257,YL
81502022,XW）
广州市科技计划项目（201506010099,YL）
中山大学青年教师培育项目（2015ykzd10,YL
13ykpy37,YL）
关键词
直肠肿瘤
复发
预后
生存
Rectal neoplasms
Recurrence
Prognosis
Survival
