Dukes B期结直肠癌根治术后复发转移分析

目的探讨Dukes B期结直肠癌根治术后复发转移相关的临床病理因素。方法应用单因素分析法,回顾性分析1990-1999年265例Dukes B期结直肠癌根治术病例的临床病理因素。结果单因素分析显示,Dukes B期大肠癌的预后与肿瘤部位有关,直肠癌术后更易发生复发转移,特别是局部复发。而性别、年龄、病程、大体类型、肿瘤大小、组织学类型、分化程度、肠壁浸润深度与术后复发转移无关。结论Dukes B期的直肠癌患者术后局部复发的风险较大。     

结直肠癌根治术后复发模式

目的:探讨结直肠癌根治术后复发模式.方法:回顾性分析1990年至1999年行根治术的692例结直肠癌病例,术后出现复发162例.结果:复发转移率23.4%(162/692),复发转移在术后2年内出现者占74.1%(120/162),3年内出现者占92.0%(149/162).结肠癌、直肠癌术后复发转移率分别为16.3%(46/282)、28.3%(116/410).结肠癌69.6%(32/46)为单纯远处转移,最常见的远处转移位置是肝脏.直肠癌41.4%(48/116)为单纯局部复发,10.3%(12/116)为兼有局部复发和远处转移.结论:结直肠癌术后2～3年应加强随访.结肠癌术后最常见的复发是远处转移,直肠癌则为局部复发.     

Dukes B期结直肠癌根治术后复发转移分析

目的探讨Dukes B期结直肠癌根治术后复发转移相关的临床病理因素。方法应用单因素分析法，回顾性分析1990—1999年265例Dukes B期结直肠癌根治术病例的临床病理因素。结果单因素分析显示，Dukes B期大肠癌的预后与肿瘤部位有关，直肠癌术后更易发生复发转移，特别是局部复发。而性别、年龄、病程、大体类型、肿瘤大小、组织学类型、分化程度、肠壁浸润深度与术后复发转移无关。结论Dukes B期的直肠癌患者术后局部复发的风险较大。     

结直肠癌淋巴结转移的多因素分析

目的探讨结直肠癌淋巴结转移的相关临床病理因素。方法回顾分析广西医科大学第一附属医院结直肠肛门外科2008年4月至2009年12月手术治疗的291例结直肠癌病例资料,采用单因素和Logistic多因素回归分析方法,研究结直肠癌淋巴结转移与临床病理因素之间的关系。结果单因素分析显示,性别、年龄、肿瘤部位、肿瘤占肠腔周径、肿瘤大小、大体类型、组织类型与结直肠癌淋巴结转移无关,而肿瘤分化程度、肠壁浸润深度、术前血癌胚抗原（CEA）水平与淋巴结转移有关。Logistic多因素回归分析显示,肿瘤分化程度和肠壁浸润深度与淋巴结转移有关。结论肿瘤分化程度和肠壁浸润深度是影响结直肠癌淋巴结转移的重要危险因素。     

直肠癌根治术后局部复发危险因素分析

目的 探讨影响直肠癌根治术后局部复发的相关因素,为直肠癌治疗提供依据.方法 回顾性分析1994年8月至2004年6月间收治的535例直肠癌根治手术病例的临床资料和随访结果,比较各临床病理因素与局部复发的关系.结果 本组局部复发53例(9.9%),其中合并远处复发转移病例39例(7.3%).首次手术至复发时间4～54个月,中位时间12个月.单因素分析显示,肿瘤位置(P<0.001)、分化程度(P<0.001)、组织学分型(P=0.038)、有无淋巴结转移(P=0.023)、Dukes分期(P=0.045)、有无输血(P=0.001)和术中是否应用全直肠系膜切除术(TME)原则(P<0.001)与肿瘤根治术后局部复发有关;而手术方式(P=0.908)、肿瘤浸润深度(P=0.735)、肿瘤大体病理分型(P=0.562)、手术医生年资(P=0.171)和术后辅助化疗与否(P=0.772)与根治术后局部复发无关.多因素分析显示,输血情况、肿瘤位置、分化程度、淋巴结转移和术中TME的应用是直肠癌根治术后局部复发的影响因素.结论 有输血、肿瘤位置低、分化程度低和有淋巴结转移的直肠癌患者较易复发,术中严格遵守TME原则是降低直肠癌术后局部复发的关键.     

进展期结直肠癌淋巴结转移规律的相关因素探讨

目的：探讨进展期结直肠癌经淋巴结转移规律，指导手术清扫范围，以期提高根治效果。方法：回顾性分析了124例进展期结直肠癌的住院资料、术后切除标本的淋巴结解剖数目以及病理检查结果，按照性别、年龄、肿瘤直径、解剖部位、分化程度以及临床病理分期进行统计学比较，分析淋巴结转移规律的相关因素。结果：结直肠癌经淋巴结转移与肿瘤的部位、浸润深度及分化程度明显相关。直肠癌淋巴结转移高于结肠癌，T3～T4结直肠癌的淋巴结转移率及转移度显著高于T1～T2（P〈0．05），低分化肿瘤的淋巴结转移率和转移度高于高分化肿瘤（P〈0．05）。性别、年龄以及肿瘤的肠腔内直径不是结直肠癌经淋巴结转移的相关因素。结论：肿瘤浸润肠壁的深度、细胞分化程度及癌灶的部位是结直肠癌经淋巴结转移的好发因素。手术应根据淋巴结转移规律合理地廓清淋巴结，对于直肠癌肿、T3期或无远处转移的T4期、术前结肠镜检查发现同时有2个或以上瘤灶、术前病理报告为未分化腺癌的病例，相应的结直肠系膜切除更应该彻底，以尽大可能地去除转移的淋巴结和潜在的微转移灶。     

直肠癌患者根治性前切除术后复发转移的单因素和多因素分析

目的探讨直肠癌患者根治性前切除术后复发转移的相关临床病理因素。方法应用单因素和多因素分析方法,回顾性分析1990年至1999年262例直肠癌根治性前切除术患者的临床病理因素。结果单因素分析显示,Dukes分期、淋巴结转移、肿瘤部位、分化程度、远切缘长度与直肠癌前切除术后复发转移有关,肿瘤部位、远切缘长度与局部复发有关。多因素分析显示,分化程度和远切缘长度是影响术后复发转移的预后因素,远切缘长度是影响术后局部复发的预后因素。结论肿瘤分化程度和远切缘长度是影响直肠癌患者根治性前切除术后复发转移的重要预后因素,肿瘤远切缘短的患者术后局部复发的风险增大。     

结直肠癌腹膜种植转移的危险因素分析

目的 探讨结直肠癌腹膜种植转移的危险因素.方法 回顾性分析2003年1月至2008年12月南方医院普通外科收治的873例结直肠癌患者的临床病理资料,研究结直肠癌腹膜种植转移与临床和病理因素的关系.结果 873例患者中,腹膜种植转移97例（11.1%）.单因素分析显示,患者的年龄（P=0.032）、肿瘤大小（P=0.001）、肿瘤分化程度（P=0.008）、肠壁浸润深度（P=0.000）、淋巴结转移（P=0.000）、术前CEA（P=0.003）和血清糖链抗原19-9（CA19-9）水平（P=0.009）与结直肠癌腹膜种植转移有关.Logistic多因素回归分析显示,肠壁浸润深度、淋巴结转移以及术前CEA和CA19-9水平与结直肠癌腹膜种植转移有关（均P＜0.05）.结论 肠壁浸润深度、淋巴结转移、术前CEA及CA19-9水平是影响结直肠癌腹膜种植转移的独立危险因素.     

右半结肠癌淋巴结转移的相关病理因素分析

目的探讨影响右半结肠癌淋巴结转移的相关病理因素。方法回顾性分析广西医科大学第一附属医院结直肠外科2008年9月至2011年10月行根治性切除的168例右半结肠癌患者病理资料,采用单因素分析和Logistic多因素回归分析方法,研究右半结肠癌淋巴结转移与临床病理因素之间的关系。结果单因素分析显示右半结肠癌淋巴结转移与年龄、性别、肿瘤部位、大体类型、肿瘤直径等因素无关(P>0.05);肿瘤病理类型、分化程度、浸润深度与淋巴结转移有关(P<0.05);Logistic多因素回归分析显示,肿瘤分化程度、浸润深度是影响右半结肠癌淋巴结转移的独立因素(P<0.05)。结论右半结肠癌淋巴结转移与肿瘤病理类型、分化程度、肠壁浸润深度有关,其中肠壁浸润深度是影响淋巴结转移的最重要因素。     

不同肿瘤原发部位对结直肠癌根治术后远处转移的影响研究

目的探讨不同肿瘤原发部位对结直肠癌根治术后远处转移的影响。方法回顾性分析本院236例结直肠癌根治术患者的临床资料,对患者一般资料(性别、年龄、肿瘤大小、肿瘤类型、肿瘤原发部位、分化程度、肿瘤TNM分期、手术方式)进行单因素、Logistic多因素回归分析,并分析其对术后总体远处转移的影响。结果本次研究中共发生远处转移46例,发生率为19.49%。肿瘤原发部位、肿瘤TNM分期与结直肠癌根治术后远处转移有关(均P0.05)。Logistic多因素回归分析结果显示,肿瘤原发部位、肿瘤TNM分期是结直肠癌根治术后远处转移的独立危险因素(均P0.05)。右半结肠癌、左半结肠癌、直肠癌根治术后远处转移率依次呈递增趋势。在肝转移率方面,直肠癌高于右半结肠癌(P0.05),与左半结肠癌差异无统计学意义(P0.05)。在肺转移率方面,直肠癌高于右半结肠癌、左半结肠癌(均P0.05)。右半结肠癌、左半结肠癌、直肠癌的腹膜转移、骨转移差异均无统计学意义(均P0.05)。结论肿瘤原发部位与结直肠癌根治术后总体远处转移密切相关,其中直肠癌术后总体远处转移发生率最高,左半结肠癌其次,故临床应重视此类患者术后辅助治疗,以降低远处转移率,改善预后。     

Prognostic Factors in 2230 Korean Colorectal Cancer Patients: Analysis of Consecutively Operated Cases

To define the prognostic factors in Korean colorectal cancer patients, univariate and multivariate analysis were performed on data from 2230 consecutive patients who underwent resection for colorectal cancer at the Seoul National University Hospital. The prognostic variables used for the analysis included patient's age, gender, bowel obstruction, bleeding, symptom duration, preoperative leukocyte count, preoperative serum carcinoembryonic antigen (CEA) level, Dukes' stage, tumor location, tumor size, depth of bowel wall invasion, number of lymph node metastases, histologic differentiation, and gross morphology of tumor. The overall 5-year survival rate was 62%. In the univariate analysis, all the factors except sex, symptom duration, and tumor size were associated with prognosis. Among the factors significant in the univariate analysis, Dukes' stage (p < 0.001), number of lymph node metastasis (p < 0.001), CEA level (p < 0.001), tumor location (p= 0.003), gross morphology of tumor (p= 0.017), and depth of bowel wall invasion (p= 0.031) were significant in the multivariate analysis. Several differences in prognostic factors between colon cancer and rectal cancer were observed. In the multivariate analysis, gross tumor morphology was significant only for colon cancer, and histologic differentiation was significant only for rectal cancer. Lymph node metastasis was an independent prognostic variable for both colon and rectal cancer, but its significance was more prominent for rectal cancer. Although Dukes' stage is the most reliable prognostic predictor, this study shows that other factors (preoperative CEA level, gross morphology of tumor, location of tumor, nodal status) also provide important information for the outcome of the patient.     

影响T1～2期结直肠癌淋巴结转移和预后的因素分析

目的 探讨影响T1～2期结直肠癌淋巴结转移及预后的因素,为临床治疗提供参考.方法 回顾性分析上海第二军医大学附属长海医院1999年1月至2005年1月行结直肠癌根治手术并经病理证实为T1～2期的132例患者的临床资料.结果 肿瘤部位和肿瘤浸润深度是影响本组T1～2期结直肠癌患者淋巴结转移的独立危险因素（分别为P＜0.01和P＜0.05）;而患者性别、年龄、肿瘤大体类型、肿瘤组织学类型、肿瘤分化程度、CEA水平、肿瘤直径均与其淋巴结转移无关（均P＞0.05）.淋巴结转移和术后随访过程中远处脏器的转移是影响患者生存的独立危险因素（分别为P＜0.05和P＜0.01）.结论 影响T1～2期结直肠癌患者淋巴结转移的因素并不影响患者的生存,但淋巴结转移和远处脏器转移是影响预后的危险因素     

结肠癌根治术后复发的多因素分析

目的探讨结肠癌根治术后复发的因素。方法对2000年1月～2005年1月收治的135例结肠癌患者的临床资料进行回顾性分析。选择对结肠癌术后复发可能产生影响的临床因素,通过Cox比例风险模型进行多因素分析。结果全组患者复发率为16.3％。单因素分析显示,淋巴结转移、肿瘤大小、Dukes’分期和肿瘤细胞分化程度与结肠癌根治术后肿瘤复发有关。多因素分析显示,淋巴结转移和肿瘤细胞分化程度与结肠癌根治术后肿瘤复发有关。结论淋巴结转移和肿瘤细胞分化程度是影响结肠癌术后复发的独立危险因素。     

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??Clinicopathological Characteristics Associated with Lymph Node Metastasis in Early Gastric Cancer with Submucosal Invasion SHEN Li-zong, HUANG Yi-ming, SUN Mao-cai, et al. Department of General Surgery, the First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China Corresponind author: SHEN Li-zong, E-mail: shenlz@163.com Abstract Objective To investigate the clinicopathological characteristics of early gastric cancer with submucoal invasion associated with lymph node metastasis. Methods The data from 181 patients surgically treated for early gastric cancer with submucosal invasion between 1998 and 2007 were reviewed retrospectively. The clinicopathological variables associated with lymph node metastasis were evaluated. Results Lymph node metastasis was observed in 20.44% of patients. The histological classification, tumor size, location in the stomach and presence of vascular or lymphatic invasion showed a positive correlation with the rate of lymph node metastasis by univariate analysis. Multivariate analyses revealed histological classification and tumor size to be significantly and independently related to lymph node metastasis. Conclusion Histological classification, tumor size, location in the stomach and presence of vascular or lymphatic invasion are risk factors for lymph node metastasis in early gastric cancer with submucoal invasion. Minimal invasive treatment, such as endoscopic submucosal dissection, may be possible in highly selective cancers.     

Intersphincteric Resection for Very Low Rectal Adenocarcinoma: Univariate and Multivariate Analyses of Risk Factors for Recurrence

Background  The aim of this study was to analyze the risk factors for local and distant recurrence after intersphincteric resection (ISR) for very low rectal adenocarcinoma. Methods  One hundred twenty consecutive patients with T1–T3 rectal cancers located 1–5 (median 3) cm from the anal verge underwent ISR. Univariate and multivariate analyses of prospectively recorded clinicopathologic parameters were performed. Results  Fifty patients had disease categorized as stage I, 21 as stage II, 46 as stage III, and 3 as stage IV on the basis of International Union Against Cancer tumor, node, metastasis staging system. Median follow-up time was 3.5 years. The 3-year rates of local and distant recurrence were 6% and 13%, respectively. Univariate analysis of the risk factors for local recurrence revealed pathologic T, pathologic stage, focal dedifferentiation, microscopic resection margins, and preoperative serum CA 19-9 level to be statistically significant. Multivariate analysis showed resection margin, focal dedifferentiation, and serum CA 19-9 level to be independently significant. Univariate analysis of the risk factors for distant recurrence indicated tumor location, combined resection, tumor annularity, pathologic N, lateral pelvic lymph node metastasis, pathologic stage, histologic grade, lymphovascular invasion, perineural invasion, and adjuvant chemotherapy to be significant. Multivariate analysis identified pathologic N, histologic grade, and tumor location to be independently significant. Conclusion  Profiles of risk factors for local and distant recurrences after ISR are different. With local recurrence, the resection margin, focal dedifferentiation, and serum CA 19-9 level are important. For distant recurrence, the lymph node status, histologic grade, and tumor location need to be taken into account.     

Histoclinical Analysis of Early Colorectal Cancer

To evaluate the clinicopathologic characteristics of early colorectal cancer (ECC), histopathologic and clinical features of 90 ECC patients who underwent surgical resection (not including the endoscopic polypectomized cases) and 1704 patients with advanced colorectal cancer were analyzed. Smaller size, better histologic differentiation, less lymph node (LN) metastasis, and better clinical outcome were observed in those with ECC than in patients with more advanced lesions. LN metastasis was found in 5 patients with ECC among the 56 patients who underwent bowel resection (8.9%). Tumors with LN metastasis were more frequently associated with deep submucosal invasion, absence of an adenomatous component within the tumor, sessile configuration, and lymphovascular invasion. Tumors showing deep submucosal layer invasion were associated with a more unfavorable histologic grade, lymphovascular invasion, LN metastasis, sessile morphology, and absence of an adenomatous component within the tumor. Recurrence was observed in two patients who underwent local excision for their submucosal cancer. One of the patients was salvaged after bowel resection, but one patient died of distant metastasis. From our data analysis and literature review, extensive submucosal invasion, lymphovascular invasion, sessile configuration, and tumors with no adenomatous component should be considered high risk factors for LN metastasis and recurrence after limited therapy.     

Significant prognostic factors in patients with early gastric cancer

BACKGROUND: Early gastric cancer is defined as a gastric carcinoma confined to the mucosa or submucosa regardless of lymph node status, and it has an excellent prognosis with a 5-year survival rate of more than 90%. From 1985 to 1995, we encountered 266 cases of early gastric cancer in our hospital. METHODS: A retrospective analysis of the 266 cases of early gastric cancer was performed to evaluate the prognostic significance of clinicopathological features (age, gender, tumor size, tumor location, depth of invasion, lymph node metastasis, histological type, lymphatic invasion, vascular invasion, histological growth pattern, cancer-stromal relationship and type of operation). RESULTS: The overall survival rate of all the patients with early gastric cancer was 95.7%. In univariate analysis, the statistical significant prognostic factors were regional lymph node metastasis (P = 0.0004), lymphatic invasion (P = 0.0053) and cancer-stromal relationship (P = 0.0016). Absence of lymph node metastasis and lymphatic invasion, and a medullary-type histopathology were associated with improved survival. In multivariate analysis, the statistically significant prognostic factors were lymph node metastasis and cancer-stromal relationship. CONCLUSIONS: Presence of lymph node involvement and a scirrhous type of gastric cancer are associated with poor prognosis. Lymph node dissection with gastric resection is necessary for patients with early gastric cancer who have a high risk of lymph node metastasis. Postoperative chemotherapy is recommended for a scirrhous type of early gastric cancer.