14例转移性结直肠癌合并消化道穿孔临床病理特征及预后的回顾性系列分析

目的分析转移性结直肠癌合并消化道穿孔病例临床病理特征及预后。方法采用描述性病例系列研究方法回顾性分析2019年11月至2020年11月北京大学肿瘤医院消化内科收治的转移性结直肠癌合并消化道穿孔的14例患者临床病理及穿孔前后CT影像特征。并将14例患者中穿孔后积极手术干预的12例患者分为2组:术后继续抗肿瘤治疗组和术后最佳支持治疗组,随访两组患者的生存状态,绘制生存曲线,采用Log-rank法比较两组患者生存曲线的差异。结果14例转移性结直肠癌合并消化道穿孔患者中,男性9例(64.3%)、年龄≥60岁10例(71.4%)、左半结肠癌10例(71.4%)、RAS/BRAF突变型10例(71.4%)、一线治疗11例(78.6%)、肠梗阻同时合并消化道穿孔8例(57.1%);14例晚期结直癌合并消化道穿孔的患者中有10例在抗肿瘤治疗中出现穿孔,其中使用血管内皮生长因子(vascular endothelial growth factor,VEGF)抑制剂7例,治疗有效8例。穿孔术后继续抗肿瘤组总生存期显著优于穿孔术后最佳支持治疗组,差异有统计学意义(P<0.05)。结论转移性结直肠癌合并消化道穿孔临床特征包括老年、男性、左半、RAS/BRAF突变、肠梗阻、影像学显示局部分期T_4a~T_4b、憩室等。另外,晚期肠癌治疗中使用血管生成抑制剂及抗肿瘤治疗有效时也需高度警惕消化道穿孔风险。转移性结直肠癌合并消化道穿孔积极手术干预后继续进行抗肿瘤治疗生存获益。

Retrospective case series analysis of clinicopathological features and prognosis of 14 patients with advanced colorectal cancer complicated with gastrointestinal perforation

Objective To investigate the clinicopathological features and prognosis of patients with advanced colorectal cancer complicated with gastrointestinal perforation.Methods Clinicopathological features of 14 patients with advanced colorectal cancer with gastrointestinal perforation in the Department of Gastroenterology,Peking University Cancer Hospital were retrospectively analyzed from Nov.2019 to Nov.2020.The 12 patients who received active surgical intervention after perforation were divided into two groups among 14 patients:the anti-tumor treatment group and the best-supportive treatment group.The survival status of the two groups was followed up.The difference of the overall survival between the two groups was compared using Log-rank test.Results Among the 14 patients,9 patients(64.3%)were male,10 patients(71.4%)were over 60 years old.10 patients were left colon cancer(71.4%).10 patients(71.4%)of them were RAS/BRAF mutated.11 patients(78.6%)were in first-line treatment.8 patients(57.1%)had gastrointestinal perforation with simultaneous intestinal obstruction.Among the 14 patients,10 patients had been treated with anti-tumor therapy before perforation,among which 7 patients were treated with vascular endothelial growth factor(VEGF)inhibitors.8 patients had partial response or stable disease as best response.The overall survival of the anti-tumor group after perforation was better than that of the best-supportive treatment group after perforation,and the difference was statistically significant(P<0.05).Conclusion Elderly,male,left hemiplegia,RAS/BRAF mutation,intestinal obstruction,local staging T_4a-T _4b,diverticulum may be risk factors of gastrointestinal perforation in advanced colorectal cancer.In addition,gastrointestinal perforation should be watched out when anti-VEGR agent was used.Patients with advanced colorectal cancer complicated with gastrointestinal perforation could benefit from anti-tumor treatment after active surgical intervention.