结直肠癌根治术后复发转移危险因素分析

目的探讨结直肠癌根治术后复发转移的相关因素。方法应用单因素和多因素Cox分析方法,回顾性分析1990—1999年692例结直肠癌根治术后病例的临床病理因素。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)。3、5年生存率:复发转移组分别为33.1%和19.7%,非复发转移组分别为92.8%和86.1%。单因素分析显示,结直肠癌患者的Dukes分期、淋巴结转移、肠壁浸润深度、分化程度、肿瘤部位、大体类型与复发转移有关。多因素分析显示,结直肠癌的淋巴结转移、肿瘤部位、分化程度是复发转移的危险因素,其中淋巴结转移是影响术后复发转移最重要的因素。分别进行局部复发和远处转移多因素分析显示,淋巴结转移、肿瘤部位、分化程度与局部复发有关,而淋巴结转移、肠壁浸润深度与远处转移有关。直肠癌多因素分析显示分化程度是术后复发的预后因素。结论淋巴结转移是影响结直肠癌术后复发转移最重要的危险因素。浸润深度是术后远处转移的重要预后因素,肿瘤位于直肠且分化程度低的患者术后局部复发的风险较大。

Risk factors for postoperative recurrence following radical resection of colorectal carcinoma

Objective To investigate the recurrence-related clinicopathologie factors following curative surgery for colorectal cancer.Methods The clinicopathologic factors and follow-up data of 692 cases of colorectal cancers after surgical treatment from 1991 to 1999 were retrospectively analyzed using univariate and multivariate method.Results The overall recurrence rate was 23.4% (162/692). 74.1% recurrences developed within two years,and 92.2% recurrence within 3 years.Univariate analysis showed that Dukes' stage,lymph node metastasis,tumor location,histological differentiation,gross classification and depth of bowel wall invasion were significantly associated with recurrence.Multivariate analysis showed that lymph node metastasis,tumor location and histological differentiation were prognostic factors for recurrence.Lymph node metastasis was highly predictive of increased risk of recurrence.In separate analysis of distant metastasis and local recurrence with multivariate method,lymph node metastasis was a prognostic variable for both distant metastasis and local recurrence,Depth of bowel wall invasion was associated with distant metastasis,and tumor location was associated with local recurrence.Multivariate analysis showed histological differentiation as a prognostic factor for recurrence.Conclusions Lymph node metastasis is the most important prognostic factor for postoperative recurrence of colorectal carcinoma. Depth of bowel wall invasion is an important prognostic factor for distant metastasis.Patients with poor- differentiated rectal cancer is subject to higher risk of local recurrence.