低位直肠癌局部切除术可行性影响因素分析

 目的　探讨局部切除术用于低位直肠癌的可行性及预后影响因素。方法　回顾性分析1975年1月至2006年12月实施局部切除术且资料完整的124例低位直肠癌患者的临床资料,采用Kaplan-Meier法进行生存分析,Log-rank检验进行统计学比较,COX比例风险模型进行多因素分析。结果　124例患者的5年生存率为90.7 %（97／107）,并发症发生率为4.8 %（6／124）,局部复发率为15.3 %（19／124）。单因素分析显示,肿瘤浸润深度、脉管瘤栓、肿瘤大小和分化程度与患者术后生存率有关;而性别、年龄、肿瘤位置、大体类型与术后生存率无关。多因素分析显示,肿瘤浸润深度是影响预后的独立危险因素。结论　Tis及T1期低位直肠癌适合采用局部切除术,部分具有高危局部复发因素的T1期低位直肠癌应选择根治术,局部切除术后患者应接受严密随访和必要的辅助治疗。     

160 例胃癌根治术后预后分析*

目的:探讨胃癌根治术后影响患者长期生存的预后因素。方法:回顾性分析天津医科大学附属肿瘤医院2001年1 月至2002年12月收治并行胃癌根治术的患者,将数据输入SPSS13.0 统计软件,通过比较1、3、5 年生存率分析各项可能影响胃癌预后的因素。结果:全组病例1、3、5 年生存率分别为72.50% 、52.50% 、45.00% 。单因素分析显示,年龄、手术方式、肿瘤最大径、Borrmann 分型、联合脏器切除、肿瘤侵犯深度、淋巴结转移度以及临床分期与术后远期生存有关（P<0.05）。 而多因素分析显示,仅患者年龄、手术方式、肿瘤侵犯深度以及临床分期是胃癌根治术后患者预后的独立因素（P<0.05）。 结论:患者年龄、手术方式、肿瘤侵犯深度以及临床分期是影响胃癌根治术后患者预后的重要因素。      

Multivariate analysis of prognostic factors in stage I ovarian cancer

Background. As the prognosis of ovarian cancer has improved with recent therapy, some prognostic factors have lost their clinical significance. The purpose of this study was to evaluate prognostic factors in stage I ovarian cancer in patients with improved prognosis because of cisplatin combination chemotherapy. Methods. Multivariate analysis was performed with 14 clinicopathologic prognostic factors obtained from 170 patients with stage I ovarian cancer (borderline tumors were excluded), who had been surgically treated between 1983 and 1995. Results. The 5-year survival rate was 94.5% for all stage I patients, 98.0% in stage IA, 100% in stage IB, and 92.6% in stage IC. Significant prognostic factors determined by the Kaplan-Meier method were spontaneous rupture of the capsule and capsular invasion (P < 0.05, and P < 0.01). Multivariate analysis, however, showed that spontaneous rupture of the capsule was the only significant prognostic factor (P = 0.02627). Both analyses showed that histologic type, histologic grading, intrapelvic cytology, operative procedure, and chemotherapy had little influence on prognosis. Conclusion. Multivariate analysis showed that spontaneous rupture of the capsule was the only significant prognostic factor in patients with stage I ovarian cancer who received cisplatin chemotherapy. Received: January 19, 1998 / Accepted: October 19, 1998     

EMVI-positive stage II rectal cancer has similar clinical outcomes as stage III disease following pre-operative chemoradiotherapy

BackgroundStage II rectal cancers comprise a heterogeneous group, and there is significant variability in practise with regards to adjuvant chemotherapy; the survival benefit of chemotherapy is perceived to be <4% in these patients. However, in recent years, the emergence of additional prognostic factors such as extramural venous invasion (EMVI) suggests that there may be sub-stratification of stage II tumours and, further, we may be under-estimating the benefit adjuvant chemotherapy provides in high-risk patients. This study examined the outcomes of patients with stage II and III rectal cancer to determine whether EMVI status influences disease-free survival (DFS).Patients and methodsAn analysis of a prospectively maintained database was conducted of patients presenting with rectal cancer between 2006 and 2012. All patients underwent curative surgery and had no evidence of metastases at presentation. Clinicopathological factors were compared between stage II and III disease. The primary end point was 3-year DFS; univariate and multivariate analysis was carried out using Cox proportional hazards regression models; hazard ratios (HR) with 95% confidence intervals (CIs) were calculated.ResultsFour hundred and seventy-eight patients were included: 233 stage II; 245 stage III. The prevalence of EMVI was 34.9%; 57 stage II patients (24.5%) and 110 stage III patients (44.9%). On multivariate analysis, only EMVI status was a significant factor for DFS. The adjusted HR for EMVI either alone or in combination with nodal involvement was 2.08 (95% CI 1.10–2.95) and 2.74 (95% CI 1.66–4.52), respectively.ConclusionEMVI is an independently poor prognostic factor for DFS for both stage II and stage III rectal cancer. These results demonstrate that there is risk-stratification within stage II tumours which affects prognosis. When discussing the use of adjuvant chemotherapy with patients that have EMVI-positive stage II tumours, these results provide evidence for a similarly increased risk of distant failure as stage III disease without venous invasion.     

Prognostic Impact of Extranodal Extension in Rectal Cancer Patients Undergoing Radical Resection After Preoperative Chemoradiotherapy

BackgroundExtranodal extension (ENE) of nodal metastasis has emerged as an important prognostic factor in many malignancies, including rectal cancer. However, its significance in patients with rectal cancer receiving preoperative chemoradiotherapy (PCRT) has not been extensively investigated. We therefore assessed ENE and its prognostic impact in a large series of consecutive rectal cancer patients with lymph node metastasis after PCRT and curative resection.Patients and MethodsBetween January 2000 and December 2014, a total of 1925 patients with rectal cancer underwent surgical resection after PCRT. Medical records of 469 patients with pathologic node positivity were retrospectively reviewed.ResultsOf the 469 patients, 118 (25.2%) presented with ENE. ENE was observed more frequently in those with advanced tumor stage (higher ypT, ypN, and ypStage), lymphovascular invasion, and perineural invasion. Five-year disease-free survival rate was lower in patients with ENE-positive tumors than those with ENE-negative tumors (36.1% vs. 52.3%, P = .003). Similarly, 5-year overall survival rate was lower in patients with ENE-positive tumors than those with ENE-negative tumors (60.2% vs. 70.6%, P < .001). Multivariate analysis revealed that the presence of ENE was an independent poor prognostic factor for disease-free survival (hazard ratio = 1.412; 95% confidence interval, 1.074-1.857; P = .013) and overall survival (hazard ratio = 1.531; 95% confidence interval 1.149-2.039; P = .004).ConclusionThe presence of ENE in patients with rectal cancer undergoing PCRT is a negative prognostic factor, reflecting poor survival outcome.     

384例男性直肠癌患者预后因素分析

背景与目的:中国结直肠癌发病率逐年上升,其中直肠癌所占比例超过50%,尤以中低位直肠癌多见。男性患者由于盆腔的解剖特点,在治疗方式的选择、保肛比例及预后方面均有其自身的特点。本研究旨在探讨男性直肠癌患者临床病理特征及其与预后的关系。方法:选择年龄、病程、首发症状、肿瘤部位、肿瘤大小、肿瘤占肠腔周径比例、肿瘤大体类型、组织类型、肠壁浸润深度、Dukes@分期、淋巴结转移位置及术式等12项临床病理指标,用单因素和多因素分析的方法研究其对384例男性直肠癌患者预后的影响。结果:单因素分析显示,肿瘤部位、肿瘤大体类型、组织类型、肿瘤浸润肠壁深度、淋巴结转移位置及Dukes@分期为影响预后的因素。Cox比例危险回归模型多因素分析显示,仅组织类型及淋巴结转移位置为男性直肠癌患者预后的独立影响因素。结论:组织类型及淋巴结转移位置为男性直肠癌预后的独立影响因素。     

Prognostic Significance of the Mucin Component in Stage Ⅲ Rectal Carcinoma Patients

Background: Although mucinous adenocarcinoma has been recognized for a long time, whether it is associatedwith a poorer prognosis in colorectal cancer patients is still controversial. Many studies put emphasis on mucinousadenocarcinoma containing mucin component ≥50%. Only a few studies have analyzed cases with a mucincomponent <50%. Objectives: This study aimed to analyze the prognostic value of different mucin componentproportions in patients with stage Ⅲ rectal cancer. Materials and Methods: Clinical, pathological and follow-updata of 136 patients with the stage III rectal cancer were collected. Every variable was analyzed by univariateanalysis, then multivariate analysis and survival analysis were further performed. Results: Univariate analysisshowed pathologic T stage, lymphovascular invasion, and histological subtype were statistically significant for DFS.Pathologic T stage was significant for OS. Histological subtype and lymphovascular invasion were independentprognostic factors in multivariate analysis for DFS, and histological subtype was the only independent prognosticfactor for OS. Survival curves showed the survival time of mucinous adenocarcinoma (MUC) was shorter thannon-MUC (adenocarcinomas with a mucin component <50% and without mucin component). Conclusions:Histological subtype (tumor with different mucin component) was an independent prognostic factor for bothDFS and OS. Patients with MUC had a worse prognosis than their non-MUC counterparts with stage Ⅲ rectalcarcinoma.     

神经浸润对胃癌患者生存预后的影响

  目的  探讨神经浸润（perineural invasion，PNI）对胃癌患者生存预后的影响。  方法  回顾性分析2011年1月至2012年12月天津医科大学肿瘤医院收治的1 007例胃癌患者的临床病理资料，根据术后病理标本中有无PNI将所有患者分为PNI阴性组和PNI阳性组，分析PNI与临床病理因素的关系及其对胃癌患者生存预后的影响。  结果  1 007例胃癌患者中PNI阳性120例，阳性率为11.9%。分化程度、浸润深度和脉管癌栓是PNI的独立危险因素。单因素分析显示，年龄、肿瘤部位、Borrmann分型、肿瘤大小、根治度、TNM分期、术式、癌结节、脉管癌栓、PNI、术前CA19-9及CEA水平与胃癌患者预后相关。PNI阴性和PNI阳性患者5年生存率分别为66.6%和38.3%，差异具有统计学意义（P < 0.001）。多因素分析显示年龄、BorrmannⅣ型、TNM分期、根治度、癌结节和PNI是胃癌患者的独立预后因素。分层分析显示，PNI仅对Ⅰ、Ⅱ和Ⅲa期胃癌预后影响具有统计学意义。  结论  PNI是胃癌患者独立预后因素，可作为Ⅰ、Ⅱ和Ⅲa期患者预后评价指标。      

Association Between Prognostic Factors and Disease-Free Survival of Cervical Cancer Stage IB1 Patients Undergoing Radical Hysterectomy.

This study was designed to identify prognostic factors of patients with cervical cancer stage IB1 undergoing radical hysterectomy. The medical records and specimens of two hundred and five patients with cervical cancer stage IB1 undergoing radical hysterectomy at Songklanagarind Hospital from July 1995 to June 2005 were reviewed. Patients' age, tumor size, histologic type, tumor grade, depth of invasion, degree of stromal invasion, lymph-vascular space invasion (LVSI), surgical margin status, pelvic node status, and adjuvant treatment were assessed for correlation with disease-free survival (DFS). The mean age of these patients was 44.2 years and the median follow up was 56 months. Twenty five patients (12.2%) developed recurrent disease. The overall 5-year DFS was 86%. In univariate analysis, depth of invasion, degree of stromal invasion, LVSI, and pelvic node status were significant prognostic factors. In multivariate analysis, degree of stromal invasion remained the only independent prognostic factor. In conclusion, degree of stromal invasion was the main independent predictor of prognosis in surgical cases of cervical cancer stage IB1.     

神经侵犯在新辅助放疗后ypⅠ~Ⅱ期直肠癌中的预后预测价值

背景与目的：神经侵犯在结直肠癌中有一定的预后价值。对于局部进展期直肠癌，在接受过新辅助放疗及根治性外科手术且经术后病理学检查证实淋巴结为阴性（ypⅠ~Ⅱ）的直肠癌患者中，肿瘤可能存在不同程度的退缩，而此时神经侵犯是否还有预后价值目前尚未见报道。本研究旨在探讨神经侵犯在新辅助放疗后淋巴结阴性的直肠癌中的预后价值。方法：回顾性分析美国癌症监测、流行病学和最终结果（the Surveillance, Epidemiology, and End Results，SEER）数据库2000年—2018年5 222例接受新辅助放疗术后经病理学检查证实为ypⅠ~Ⅱ期的直肠癌患者的临床病理学资料和直肠癌特异性生存资料，采用卡方检验比较有无神经侵犯两组患者之间的基线资料差异，用Kaplan-Meier法和log-rank检验比较两组之间的生存差异，运用多因素Cox回归模型分析对患者肿瘤特异性生存有影响的因素。结果：该人群中有神经侵犯者329例，无神经侵犯者4 893例。与无神经侵犯的患者相比，有神经侵犯的患者中，黑种人、癌胚抗原（carcinoembryonic antigen，CEA）升高、Ⅱ期病灶、肿瘤小于5 cm和低分化的比例更高（P<0.05）。无神经侵犯的直肠癌患者的肿瘤特异性生存显著优于有神经侵犯的直肠癌患者（5年生存率：85.3% vs 68.9%），且此种生存差异在ypⅡ期直肠癌患者中更显著。多因素Cox回归模型提示有神经侵犯是新辅助放疗后淋巴结阴性直肠癌患者的独立预后因子。结论：神经侵犯与新辅助放疗后淋巴结阴性的直肠癌患者的生存密切相关，可作为此类患者的预后评判因子。     

Conventional clinicopathologic prognostic factors in surgically resected nonsmall cell lung carcinoma. A comparison of prognostic factors for each pathologic TNM stage based on multivariate analyses

BACKGROUND: A number of prognostic factors have been reported for resected nonsmall cell lung carcinoma. None of them, however, has been reported to have greater prognostic impact than the pathologic TNM staging system. The authors evaluated 18 conventional clinicopathologic prognostic factors in each pathologic stage. METHODS: A retrospective study was conducted on surgically resected 836 lung carcinoma patients, and the following conventional prognostic factors were evaluated in multivariate analyses: age, gender, pack-year smoking, serum carcinoembryonic antigen and squamous cell carcinoma antigen levels, laterality of tumor, clinical N status, histologic type of tumor, greatest tumor dimension, grade of differentiation, pleural involvement, lymphatic invasion, vascular invasion, degree of fibrosing scarring, nuclear atypia, mitotic activity, and curativity of resection. RESULTS: The overall 5-year survival rate was 63.8%. In 430 cases of pathologic Stage I disease, multivariate analyses revealed 3 significant prognostic factors: clinical N status (P < 0.001), vascular invasion (P = 0.001), and curativity of resection (P < 0.001). In 406 cases of more advanced disease, i.e., pathologic Stage II, IIIA, IIIB, or IV, multivariate analyses revealed 4 factors as significant: histology (P = 0.001), pathologic N status (P < 0.001), tumor size (P < 0.001), and curativity of resection (P = 0.002). CONCLUSIONS: Conventional clinicopathologic prognostic factors had a different impact on prognosis in each pathologic TNM stage among patients who underwent surgical resection of nonsmall cell lung carcinoma. These factors should be analyzed separately in each pathologic TNM stage.     

Diagnostic accuracy and prognostic impact of restaging by magnetic resonance imaging after preoperative chemoradiotherapy in patients with rectal cancer

BackgroundThe prognostic role of restaging rectal magnetic resonance imaging (MRI) in patients with preoperative CRT has not been established. The goal of this study was to evaluate the diagnostic accuracy and prognostic role of radiological staging by rectal MRI after preoperative chemoradiation (CRT) in patients with rectal cancer.MethodsA total of 231 consecutive patients with rectal cancer who underwent preoperative CRT and radical resection from January 2008 to December 2009 were prospectively enrolled. The diagnostic accuracy and prognostic significance of post-CRT radiological staging by MRI was evaluated.ResultsThe sensitivity, specificity, positive predictive value, and negative predictive value of radiological diagnosis of good responders (ypTNM stage 0–I) were 32%, 90%, 65%, and 69%, respectively. The overall accuracy of MRI restating for good responders was 68%. The 5-year disease-free survival rates of patients with radiological and pathological TNM stage 0, stage I, and stage II–III were 100%, 94%, and 76%, respectively (P = 0.037), and 97%, 87%, and 73%, respectively (P = 0.007). On multivariate analysis, post-CRT radiological staging by MRI was an independent prognostic factor for disease-free survival.ConclusionRadiological staging by MRI after preoperative CRT may be an independent predictor of survival in patients with rectal cancer.     

直肠癌术后IMRT±化疗疗效及预后分析

目的 探讨直肠癌术后IMRT±化疗的疗效及预后影响因素。方法 回顾分析2009—2013年间218例直肠癌术后IMRT患者的临床资料。共208例(95.4%)患者进行了化疗, 方案以氟尿嘧啶为主。采用Kaplan-Meier法计算生存率, Logrank检验和单因素预后分析, Cox模型多因素预后分析。结果 随访率97.7%。1、3年OS率分别为90.8%、75.2%, DFS率分别为85.3%、70.5%, LRFS率分别为96.7%、88.1%。全组3—4级急性不良反应发生率为28.4%, 主要表现为3级白细胞减少(13.8%)和腹泻(11.0%)。单因素预后分析表明术前CEA、CA199水平、肿瘤最大径、肿瘤部位、分化程度、肿瘤浸润深度、淋巴结转移数、TNM分期、神经侵犯、手术方式、TME、术前肠梗阻和术前贫血为影响因素(P=0.006、0.000、0.000、0.017、0.000、0.016、0.000、0.011、0.001、0.001、0.006、0.037和0.010);多因素预后分析显示术前CEA水平、肿瘤部位、TNM分期、术前肠梗阻和术前贫血为影响因素(P=0.000、0.000、0.000、0.001和0.001)。结论 直肠癌术后IMRT±化疗疗效肯定, 不良反应轻, 治疗依从性较高。术前CEA水平、肿瘤部位、TNM分期、术前肠梗阻和术前贫血为预后影响因素。     

Predictors for pathological parametrial invasion in clinical stage IIB cervical cancer

ObjectiveTo examine predictors of pathological parametrial invasion in clinical stage IIB cervical cancer, and to examine prognostic factors in pathological stage IIB disease.MethodsThis study is an ancillary analysis of a nation-wide retrospective cohort examining 6,003 clinical stage IB-IIB cervical cancers. Women with clinical stage IIB disease who underwent primary radical hysterectomy with lymphadenectomy were examined (n = 714). Multivariate analysis was performed to identify independent clinico-pathological factors for pathological parametrial invasion and to identify independent prognostic factors in pathological stage IIB disease.ResultsParametrial invasion was identified on the surgical specimen in 400 cases (56.0%, 95% confidence interval 52.4–59.7). On multivariate analysis, deep stromal invasion (DSI, adjusted-OR 3.922), multiple pelvic nodal metastases (adjusted-OR 3.266), lympho-vascular space invasion (adjusted-OR 2.333), and uterine corpus invasion (adjusted-OR 1.656) remained independent tumor factors for pathological parametrial invasion. In classification-tree models, tumors with DSI and multiple pelvic nodal metastases had the highest incidence of pathological parametrial invasion (75.0–87.7%); contrary, tumors without DSI had the lowest incidence (21.9%). Among patients with pathological stage IIB disease, the absolute difference in 5-year disease-free survival rates was 57.2%, ranging between 80.9% in those with squamous histology with none/single pelvic nodal metastasis and 23.7% in those with non-squamous histology with multiple pelvic nodal metastases.ConclusionIn clinical stage IIB cervical cancer, accuracy for pathological parametrial invasion is low-modest. With absence of DSI, only one in five clinical stage IIB diseases has pathological stage IIB disease. Survival of pathological stage IIB varies widely and is largely dependent on nodal factors.     

直肠癌患者组蛋白甲基转移酶hSETD1A表达水平的临床预后价值

背景与目的:组蛋白修饰是非常重要的表观遗传修饰形式,组蛋白甲基化修饰酶基因的异常表达与多种疾病及癌症的发生、发展有关。探讨直肠癌患者肿瘤组织的组蛋白甲基转移酶hSETD1A表达水平与临床预后的相关性。方法:选取2012年1月-2014年6月福建省肿瘤医院有详细临床资料和预后随访信息的直肠癌患者肿瘤组织切除标本141例及癌旁组织标本50例。采用免疫组织化学法检测h SETD1A的表达情况,分析其与直肠癌临床病理学特征(年龄、性别、肿瘤大小、T分期、淋巴结转移、神经累及等参数)及预后的关系。结果:肿瘤组织中h SETD1A的阳性表达率明显高于癌旁组织(75.2%vs26.0%,P<0.001)。此外,其阳性率的高低还与患者性别及肿瘤分化程度的不同相关(P=0.009)。而与年龄、肿瘤大小、T分期、淋巴结转移、TNM分期、神经累及、脉管癌栓、血清癌胚抗原(carcinoembryonic antigen,CEA)及CA19-9水平无关。生存分析结果显示,h SETD1A阳性组的5年生存率明显低于h SETD1A阴性组(64.4%vs 76.5%,P=0.036)。多因素COX回归分析显示,h SETD1A表达和T分期、淋巴结转移状况(N分期)是直肠癌的独立预后因素。结论:肿瘤组织hSETD1A的表达水平与直肠癌患者的预后密切相关。     

影响直肠癌患者术后生存的多因素Cox回归分析

目的　探讨直肠癌患者临床病理特征及术后生存的影响因素。方法　以 95 2例经手术治疗和病理确诊且随访资料完整的直肠癌患者为样本 ,采用单因素和多因素Cox回归分析方法分析直肠癌患者预后的影响因素。结果　直肠癌手术以Miles手术居多 ,占 5 3.5 % ,手术死亡率为 0 .3%。中分化腺癌患者 4 79例 ,占 5 0 .3%。肿瘤直径 4～ 8cm者 5 36例 ,占 5 6 .3%。 4 18例患者于术后 10 8个月内死于复发和转移。随访期间 ,5 3例发生肝转移 ,39例发生肺转移 ,12例发生骨转移。患者的平均生存时间为 (73.5 2± 1.70 )个月。总的 3,5 ,10年生存率分别为 6 7.6 %、5 5 .4 %和 38.2 %。单因素分析表明 ,患者的性别、年龄、肿瘤的根治度、病理类型、肿瘤直径、肝转移、肺转移及肿瘤的病理分期均为预后影响因素。Cox回归分析显示 ,肿瘤根治度、病理类型、肿瘤侵犯深度、淋巴结转移、肿瘤的病理分期、肝转移及肺转移是影响患者术后生存的独立因素。结论　影响直肠癌患者术后生存的独立因素有肿瘤的根治度、淋巴结转移、病理分期、侵犯深度、病理类型和肝肺转移。     

Multivariate prognostic study on large gastric cancer

BACKGROUND: Although many authors investigate the prognostic factors of gastric cancer, there are few comprehensive studies on the prognosis of patients with large gastric cancer. The aim of this study was to clarify the prognostic factors of large gastric cancer using multivariate analysis. METHODS: The study included 95 patients who underwent gastrectomy for gastric cancer measuring 10 cm or more in diameter. We examined 24 clinicopathologic factors based on patient, operation, and tumor findings. Survival rates were analyzed by the Kaplan-Meier and Mantel-Cox method, and multivariate analysis was done using the Cox proportional hazards model. RESULTS: Overall 5-year survival rate was 22%, and median survival period was 15 months. The 5-year survival rate was influenced by the tumor size, gross type, serosal invasion, extragastric lymph node metastasis, liver metastasis, peritoneal dissemination, stage of disease (I, II vs. III, IV), resection margin, and operative curability (R0 vs. R1, R2). Of these, independent prognostic factors were three tumor findings: serosal invasion (absent vs. present, odds ratio 3.06, P < 0.01), extragastric lymph node metastasis (absent vs. present, odds ratio 2.13, P < 0.05), and liver metastasis (absent vs. present, odds ratio 3.77, P < 0.05). The survival was not significantly associated with any of the patient factors or operation factors including the extent of lymph node dissection. CONCLUSION: In patients with large gastric cancer, independent prognostic factors were serosal invasion, extragastric lymph node metastasis, and liver metastasis. Prognosis after gastectomy was determined by these tumor factors and was not associated with the patient or operation factors.     

老年人直肠癌患者的预后因素分析

背景与目的:患者年龄与结直肠癌手术后疗效的关系较复杂,一般认为年龄本身不是影响结直肠癌患者预后的决定因素。但文献中有关影响老年人直肠癌患者预后因素的研究较少。因此,回顾性分析343例老年人直肠癌病例的临床病理特征,对影响患者术后生存的因素进行单因素及多因素分析。方法:10年间手术治疗60岁以上老年直肠癌患者343例,其中R0(病理根治)术261例,占76.09%;R1(镜下切端阳性)29例,占8.45%;R2(大体标本切端阳性)53例,占15.45%。低位前切除术116例,Miles术169例,其他术式58例。结果:手术死亡率为0.87%,149例患者于术后108个月内死于复发和转移。随访期间发生肝转移17例,肺转移18例,骨转移1例。患者总的平均生存时间为(72.12±2.60)个月。3、5、10年的总生存率分别为69.62%、55.73%及34.23%。单因素分析表明,术式、手术性质、病理类型、肿瘤直径、肿瘤浸润深度、淋巴结转移、肝转移、肺转移及其他远处转移是影响患者术后生存的因素;多因素回归分析显示,淋巴结转移、肝转移及肺转移是影响患者生存的独立因素。结论:影响老年直肠癌患者术后生存的因素为术式、手术性质、病理类型、肿瘤直径、肿瘤浸润深度、淋巴结转移、远处转移。独立影响因素有手术性质、淋巴结转移、肝转移及肺转移。     

影响低位直肠癌局部切除选择的因素分析

目的探讨低位直肠癌局部切除选择的影响因素。方法回顾性分析101例局部切除治疗低位直肠癌患者的临床资料。Kaplan-Meier法计算生存率,并对预后进行单因素及多因素分析。结果经肛门切除91例,经骶骨切除9例,经阴道切除1例,并发症发生率为5.9%,全组无手术死亡病例。术前放疗5例,术后放疗34例。5年生存率为91.0%,Tis、T1、T2及T3或T4病变的5年生存率分别为100%、92.6%、77.1%和83.3%;局部复发率为15.8%。单因素分析显示,肿瘤的侵袭深度、直径>3 cm、有脉管瘤栓、溃疡型癌、放射治疗和局部复发与预后有关(P<0.05)。多因素分析显示,肿瘤直径>3 cm、局部复发是影响预后最重要的因素(P<0.05)。结论低位直肠癌病理为高中分化、直径≤3 cm、无脉管瘤栓的T1病变及原位癌,是局部切除术的合理适应证。