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。     

300例结直肠癌肝转移患者的临床预后分析

目的 探讨结直肠癌肝转移患者的临床特征及预后因素.方法 对300例结直肠癌首发肝转移患者的临床特征及肝转移后的生存情况进行回顾性分析.结果 300例患者中,原发病灶位于结肠者152例,位于直肠者148例.原发肿瘤为管状腺癌272例,黏液腺癌18例,类癌5例,印戒细胞癌4例,鳞癌1例.原发肿瘤为高分化19例,中分化217例,低分化27例.无区域淋巴结转移104例,有区域淋巴结转移162例.原发肿瘤分期为Ⅰ、Ⅱ期62例,Ⅲ、Ⅳ期为237例.同时性肝转移206例,异时性肝转移94例.肝转移灶为单发48例,多发252例.肝转移灶最大直经≤5 cm249例,>5 cm 51例.300例患者转移后中位生存期为19.0个月,肝转移后1、2和5年生存率分别为79.0%、29.0%和3.0%.单因素分析结果显示,患者KPS评分、组织学分级、原发肿瘤T分期、有无区域淋巴结转移、原发肿瘤分期、有无脉管瘤栓、肝转移灶部位、肝转移灶最大直径、肝转移灶数目、同时合并其他转移均与预后有关.多因素分析结果显示,KPS评分、脉管瘤栓、肝转移灶数目、肝转移灶最大直径是结直肠癌肝转移患者预后的独立影响因素.结论 KPS评分、脉管瘤栓、肝转移灶数目和最大直径是结直肠癌肝转移患者预后的影响因素,KPS评分越高、无脉管瘤栓、肝转移灶数目越少、转移灶最大直径越小的患者预后越好.     

根治术后盆腔复发直肠癌疗效及预后因素分析

目的 分析直肠癌根治术后盆腔复发规律以及放疗疗效和影响预后的因素.方法 回顾分析2000-2006年直肠癌根治术后盆腔复发接受放疗患者93例,分别为单纯放疗21例、放化疗56例、放疗结合手术和(或)化疗16例.放疗采用60Co或加速器X线,中位剂量59.4Gy,其中90例采用常规分割技术.68例患者放疗后接受了1～8个(中位数3个)疗程化疗,42例行同步放化疗,多为氟尿嘧啶为主的化疗方案.16例患者在放疗后接受了复发灶切除术,其中RO切除7例,姑息性肿块切除9例.结果 全组共132处复发,常见复发部位为直肠周围(31.8%)和骶前区(30.3%),髂外淋巴结和腹股沟淋巴结少见(1.5%和3.0%).总随访率为92%,随访满2、5年者分别为39、4例.有局部症状的84例患者中83%(70例)放疗后症状缓解.全组2、5年局部无进展率分别为49%、22%,2、5年生存率分别为46%、14%.多因素分析结果显示复发后治疗方法是影响直肠癌根治术后复发的局部无进展率的独立预后因素,复发灶最大径、无病间期、放疗后有无远处转移是影响直肠癌根治术后复发患者生存率的独立顶后因素.结论 直肠周围区、骶前区、髂内淋巴结区是直肠癌主要复发部位;放疗可明显改善直肠癌根治术后盆腔复发患者的症状和提高生存质量,放疗联合手术和(或)化疗可提高直肠癌根治术后复发的局部无进展率,复发灶直径＞5 cm、无病间期＜2年、放疗后有远处转移是影响预后的因素.     

1826例非小细胞肺癌的预后因素分析

目的 探讨影响非小细胞肺癌(NSCLC)预后的相关因素,分析分期和脉管瘤栓对非小细胞肺癌预后的影响.方法 回顾1826例NSCLC患者的临床资料,将可能影响NSCLC预后的风险因子进行单因素和多因素分析,确定NSCLC预后的影响因素.应用Kaplan-Meier法分析分期和脉管瘤栓对患者生存率的影响.结果 单因素分析显示,影响NSCLC预后的因素为肿瘤家族史(P=0.02)、组织学类型(P=0.005)、分期(P=0.002)和脉管瘤栓(P=0.002).经Cox回归分析,分期为Ⅲ期和有脉管瘤栓是影响NSCLC预后的独立危险因素.Ⅰ、Ⅱ、Ⅲ期患者的5年生存率分别为57.4%、34.2%和18.7%(P=0.001),同一分期中,有无脉管瘤栓患者的生存率差异有统计学意义(P＜0.05),有脉管瘤栓或无脉管瘤栓者在各分期之间的生存率差异亦有统计学意义(P＜0.05),有脉管瘤栓患者复发或转移的发生率(69.9%)显著高于无脉管瘤栓者(36.7%,P＜0.001).结论 分期和脉管瘤栓是影响NSCLC预后的重要因素,并且脉管瘤栓还可作为判断NSCLC侵袭和转移的重要因子.     

局部晚期低位直肠癌术前放化疗的降期效果和加前切除的远期疗效

目的探讨局部晚期低位直肠癌术前放化疗的降期效果和加前切除与Miles手术的远期疗效的比较。方法将103例直肠癌患者分为术前放化疗+前切除组(A组,53例)和Miles手术组(B组,50例)。原发肿瘤距肛门中位距离6.2cm。临床分期Ⅱ期22例,Ⅲ期81例(TNM,UICC)。放疗采用直线加速器盆腔3～4个野照射,剂量35～45Gy,4～5周完成。化疗以氟尿嘧啶为主联合化疗。结果A、B组5年生存率分别为64.2%、43.7%(P<0.05),5年无瘤生存率分别为52.8%、31.6%(P<0.05),局部复发率分别为15.2%、19.3%(P>0.05),远处转移率分别为25.5%、48.5%(含局部复发加远处转移)(P<0.05)。A组术后病理学完全缓解率为13.2%。随访率为88.3%。结论术前放疗和化疗加前切除手术治疗局部晚期低位直肠癌的方法不但能够保肛,而且可改善5年生存率和无瘤生存率。     

Ⅰ期低位直肠癌单纯局部切除术与术后放疗的临床研究

目的 探讨Ⅰ期低位直肠癌局部切除术后加与不加放疗的疗效及失败模式。方法 回顾分析2000—2008年间进行了局部切除术的 77例Ⅰ期低位直肠腺癌患者资料,其中 41例为术后放疗。54例病理T₁期,23例病理T₂期。Kaplan-Meier法计算生存率并Logrank法检验,并行单因素预后分析。结果 随访时间满 5年者为 40例。低危组患者单纯局部切除术与术后放疗 5年无局部或区域复发生存率和总生存率均相似(86%∶83%,χ²=0.29,P=0.588和100%∶100%,χ²=1.50,P=0.221),高危组患者的 5年无局部或区域复发生存率相似(80%∶82%,χ²=0.27,P=0.600),但总生存率不同(92%∶66%,χ²=4.64,P=0.031)。全组 5年总生存率、无局部或区域复发生存率分别为83%、82%。单因素分析示病变大小、切缘状态、分化程度、肿瘤距肛缘距离及病理T分期影响 5年总生存率。全组总复发率为29%,局部或区域失败占70%,若行挽救性根治性手术 5年总生存率可达69%。结论 Ⅰ期低位直肠癌低危患者单纯局部切除术疗效可能较佳,高危者术后放疗价值待商榷;术后失败以局部复发多见,复发后行挽救性手术者有望长期生存。     

乳腺癌合并脉管瘤栓的临床病理特点及预后因素分析

目的探讨乳腺癌合并脉管瘤栓患者的临床病理特点、分子生物学特性、生存率以及影响预后的因素。方法回顾性分析262例乳腺癌合并脉管瘤栓患者的病历资料,分析其临床病理特点、分子生物学指标和各种治疗方式对生存的影响。结果全组262例患者占同期收治乳腺癌患者的5.2%,中位年龄43岁。其中,浸润导管癌247例,占94.3%。Ⅰ期患者13例(5.0%),Ⅱ期82例(31.3%),Ⅲ期154例(58.8%),Ⅳ期3例(1.1%)、未明10例(3.8%)。ER( )占67.7%,PR( )占68.0%;p53( )占54.2%;PENA( )占93.3%;c-erbB2( )占20.8%,c-erbB2( )占16.9%。单因素分析结果显示,影响无病生存率的因素为肿瘤大小、淋巴结状态、分期以及是否放疗。影响总生存率的因素为肿瘤大小、淋巴结状态、分期、脉管瘤栓的位置以及是否放疗;多因素分析结果显示,淋巴结转移和是否放疗是影响预后的独立因素。5年和10年无病生存率分别为57.6%和50.7%, 5年和10年总生存率分别为62.8%和52.9%。结论乳腺癌合并脉管瘤栓患者具有较差的生物学特性,手术和放化疗是主要的治疗方式,影响预后的独立因素为淋巴结转移和放疗。抗血管和淋巴管生成靶向治疗可能具有应用前景。     

108例Tis~1N0M0期中低位直肠癌经肛门局部切除的临床评价

[目的]探讨Tis~1N0M0期中低位直肠癌经肛门局部切除的合理性。[方法]回顾性分析经肛门局部切除治疗的108例Tis~1N0M0期中低位直肠癌患者的资料。其中TisN0M063例,T1N0M045例。8例T1期患者接受了术后辅助放疗。[结果]所有患者术后恢复顺利,中位住院时间5d(3~8d)。无吻合口漏、直肠狭窄、肛瘘及其他手术并发症。术后肛门括约肌功能良好。5年总生存率为99.07%,Tis、T1期5年生存率分别为100%和97.78%。5年总复发率为1.85%,Tis、T1期5年复发率分别为0、4.44%。[结论]对Tis~1N0M0期中低位直肠癌患者,经肛门局部切除术既保证了生存率,又兼顾了患者的生存质量,为一种较为理想的术式选择。     

119例甲状腺滤泡状癌患者的治疗及预后因素分析

目的 探讨甲状腺滤泡状癌的最佳治疗方案以及影响患者预后的相关因素.方法 回顾性分析119例甲状腺滤泡状癌患者的临床资料.采用Kaplan-Meier法计算生存率,影响患者预后的单因素分析采用Log rank检验,多因素分析采用Cox回归模型.结果 119例甲状腺滤泡状癌患者的5和10年总生存率分别为81.1％和66.7％,就诊时患者的远处转移率为16.0％,3、5、10年累积远处转移率分别为27.4％、29.6％和35.9％.术后行131Ⅰ治疗16例,治疗效果满意9例.单因素分析结果显示,年龄、肿瘤直径、肿瘤生长方式、临床分期和脉管瘤栓均与患者的远处转移情况有关(均P＜0.05);年龄、肿瘤直径、肿瘤生长方式、pN分期、M分期、临床分期、有无脉管瘤栓和肿瘤切除程度均与患者预后有关(均P ＜0.05).Cox回归分析结果显示,年龄是影响患者远处转移的独立危险因素(P＜0.05);肿瘤直径、有无脉管瘤栓、肿瘤切除程度及有无远处转移是影响患者生存的独立因素(均P＜0.05).结论 甲状腺滤泡状癌常呈弥漫性生长,伴有脉管瘤栓,预后相对不良.手术彻底切除是提高局部控制率和改善患者预后的关键.对于年龄≥45岁患者,建议行全甲状腺切除联合131Ⅰ治疗等.     

早期低位直肠癌局部切除23例疗效分析

背景与目的:目前,早期低位直肠癌经肛门局部切除术越来越受到重视,因为它可以达到与开腹根治术类似的疗效。本研究目的是探讨早期低位直肠癌局部切除的疗效。方法:回顾性分析1989年2月～1999年4月间我院局部切除早期低位直肠癌23例的临床资料。结果:(1)12例为直肠腺癌,11例为腺瘤恶变;(2)23例中T0期17例,T1期6例;(3)有3例局部复发,其中2例再次经肛门局部扩大切除治愈,另外1例经腹会阴联合切除术;(4)本组病例术后随访均超过5年,5年生存率为95.65%。结论:只要严格掌握手术适应证,局部切除治疗早期直肠癌可取得较好的疗效,是一种切实可行的方法。     

Local excision and postoperative radiotherapy for distal rectal cancer

To assess the outcome following local excision and postoperative radiotherapy (RT) for distal rectal carcinoma.

Seventy-three patients received postoperative radiotherapy following local surgery for primary rectal carcinoma at Princess Margaret Hospital from 1983 to 1998. Selection factors for postoperative RT were patient preference, poor operative risks, and “elective” where conservative therapy was regarded as optimal therapy. Median distance of the primary lesion from the anal verge was 4 cm (range, 1–8 cm). There were 24 T1, 36 T2, and 8 T3 lesions. The T category could not be determined in 5. Of 55 tumor specimens in which margins could be adequately assessed, they were positive in 18. RT was delivered using multiple fields by 6- to 25-MV photons. Median tumor dose was 50 Gy (range, 38–60 Gy), and 62 patients received 50 Gy in 2.5-Gy daily fractions. The tumor volume included the primary with 3–5 cm margins. No patients received adjuvant chemotherapy. Median follow-up was 48 months (range, 10–165 months).

Overall 5-year survival and disease-free survival were 67% and 55%, respectively. Tumor recurrence was observed in 23 patients. There were 14 isolated local relapses; 6 patients developed local and distant disease; and 3 relapsed distantly only. For patients with T1, T2, and T3 lesions, 5-year local relapse-free rates were 61%, 75%, and 78%, respectively, and 5-year survival rates were 76%, 58%, and 33%, respectively. The 5-year local relapse-free rate was lower in the presence of lymphovascular invasion (LVI) compared to no LVI, 52% vs. 89%, p = 0.03, or where tumor fragmentation occurred during local excision compared to no fragmentation, 51% vs. 76%, p = 0.02. Eleven of 14 patients with local relapse only underwent abdominoperineal resection, 8 achieved local control, and 4 remained cancer free. The ultimate local control, including salvage surgery, was 86% at 5 and 10 years. The 5-year colostomy-free rate was 82%. There were 2 patients who experienced RTOG Grade 3 late complications, and 1 with Grade 4 complication (bowel obstruction requiring surgery).

The local relapse rate for patients with T1 disease was high compared to other series of local excision and postoperative RT. Patients with LVI or tumor fragmentation during excision have high local relapse rates and may not be good candidates for conservative surgery and postoperative RT.     

T3N0 rectal cancer: radiation for all?

The optimal oncologic management for patients with T3N0 rectal cancer is currently controversial. Patients with pathologic T3N0 disease may have an "intermediate" risk of disease recurrence, suggesting that perhaps trimodality therapy may not be indicated for all patients. Adverse prognostic features, including a greater depth of perirectal fat invasion, poor tumor differentiation, the presence of lymphovascular invasion, abnormally elevated pretreatment carcinoembryonic antigen levels (>5 ng/mL), circumferential margin involvement, and a low-lying position may identify T3N0 patients at high risk for local recurrence who may benefit from the addition of radiation therapy. However, recent randomized data suggest an improvement in local control and disease-free survival with preoperative radiation therapy compared with selective postoperative radiation therapy in all patient subgroups, arguing in favor of routine preoperative therapy. Additionally, rates of clinical understaging may exceed 20%, representing the percentage of patients who would require the delivery of postoperative radiotherapy with its associated sequelae. Future prospective randomized studies of T3N0 patients with upfront stratification by known prognostic factors and studies evaluating the molecular profile of rectal cancers hold the promise of better classifying patients at high risk of local and systemic recurrence, and thus, in need of adjuvant radiation and chemotherapy.     

Locoregional failure of postmastectomy patients with 1-3 positive axillary lymph nodes without adjuvant radiotherapy

PURPOSE: To analyze the incidence and risk factors for locoregional recurrence (LRR) in patients with breast cancer who had T1 or T2 primary tumor and 1-3 histologically involved axillary lymph nodes treated with modified radical mastectomy without adjuvant radiotherapy (RT). MATERIALS AND METHODS: Between April 1991 and December 1998, 125 patients with invasive breast cancer were treated with modified radical mastectomy and were found to have 1-3 positive axillary nodes. The median number of nodes examined was 17 (range 7-33). Of the 125 patients, 110, who had no adjuvant RT and had a minimum follow-up of 25 months, were included in this study. Sixty-nine patients received adjuvant chemotherapy and 84 received adjuvant hormonal therapy with tamoxifen. Patient-related characteristics (age, menopausal status, medial/lateral quadrant of tumor location, T stage, tumor size, estrogen/progesterone receptor protein status, nuclear grade, extracapsular extension, lymphovascular invasion, and number of involved axillary nodes) and treatment-related factors (chemotherapy and hormonal therapy) were analyzed for their impact on LRR. The median follow-up was 54 months. RESULTS: Of 110 patients without RT, 17 had LRR during follow-up. The 4-year LRR rate was 16.1% (95% confidence interval [CI] 9.1-23.1%). All but one LRR were isolated LRR without preceding or simultaneous distant metastasis. According to univariate analysis, age <40 years (p = 0.006), T2 classification (p = 0.04), tumor size >==3 cm (p = 0.002), negative estrogen receptor protein status (p = 0.02), presence of lymphovascular invasion (p = 0.02), and no tamoxifen therapy (p = 0.0006) were associated with a significantly higher rate of LRR. Tumor size (p = 0.006) was the only risk factor for LRR with statistical significance in the multivariate analysis. On the basis of the 4 patient-related factors (age <40 years, tumor >==3 cm, negative estrogen receptor protein, and lymphovascular invasion), the high-risk group (with 3 or 4 factors) had a 4-year LRR rate of 66.7% (95% CI 42.8-90.5%) compared with 7.8% (95% CI 2.2-13.3%) for the low-risk group (with 0-2 factors; p = 0.0001). For the 110 patients who received no adjuvant RT, LRR was associated with a 4-year distant metastasis rate of 49.0% (9 of 17, 95% CI 24.6-73.4%). For patients without LRR, it was 13.3% (15 of 93, 95% CI 6.3-20.3%; p = 0.0001). The 4-year survival rate for patients with and without LRR was 75.1% (95% CI 53.8-96.4%) and 88.7% (95% CI 82.1-95.4%; p = 0.049), respectively. LRR was independently associated with a higher risk of distant metastasis and worse survival in multivariate analysis. CONCLUSION: LRR after mastectomy is not only a substantial clinical problem, but has a significant impact on the outcome of patients with T1 or T2 primary tumor and 1-3 positive axillary nodes. Patients with risk factors for LRR may need adjuvant RT. Randomized trials are warranted to determine the potential benefit of postmastectomy RT on the survival of patients with a T1 or T2 primary tumor and 1-3 positive nodes.     

Surgical outcomes after total mesorectal excision for rectal cancer

BACKGROUND AND OBJECTIVES: This study reviewed the results of surgery for distal rectal cancer following the introduction of total mesorectal excision (TME) for rectal cancer. METHODS: Two hundred sixty-four patients who had undergone elective curative surgical resection of rectal cancer within 12 cm of the anal verge were included. Comparisons were made between patients who had different surgical procedures. RESULTS: The overall operative mortality rate was nil, and the morbidity 39.4%. With a mean follow-up of 34 months (range 5-105 months), local recurrence occurred in 21 of the patients. The 3- and 5-year actuarial local recurrence rates were 9% and 12%, respectively for the whole group. Abdominoperineal resection (APR) was necessary in 65 of 264 (24.6%) of the patients, with a very low local recurrence rate in this subgroup (5% at 3 years). On multivariate analysis, only stage was a significant prognosticator of overall survival (P = 0.012). CONCLUSIONS: With the practice of TME, APR was still necessary in 25% of patients with rectal cancer within 12 cm of the anal verge. Type of surgery and tumor distance from the anal verge influenced local recurrence rates, but only initial tumor stage was associated with long-term survival.     

Do all locally advanced rectal cancers require radiation? A review of literature in the modern era

Potentially curable rectal cancer is primarily treated with surgical resection. Adjuvant or neoadjuvant radiotherapy is often utilized for patients deemed to be at unacceptable risk for local recurrence. The purpose of this article is to review the pertinent literature and elucidate the role of radiotherapy in patients with an intermediate risk of local recurrence. The addition of chemoradiotherapy is recommended in the majority of patients with transmural or node positive rectal cancer. However, some patients with favorable characteristics may have only a small incremental benefit from the addition of radiotherapy. The decision to treat or not to treat should take into consideration the patient and physician tolerance of risk of recurrence and risk of treatment related toxicity. The primary factors identified for determining low risk patients are circumferential radial margin (CRM), location within the rectum, and nodal status. Patients at lowest risk have widely negative CRM (>2mm), proximal lesions (>10cm from the anal verge), and no nodal disease. Patients with all three low risk factors have an absolute reduction in local recurrence that is <5% and may be eligible to forego radiotherapy. Additional factors identified which may impact local recurrence risk are elevated serum CEA level, lymphovascular space invasion, pathologic grade, and extramural space invasion.     

直肠癌根治术后复发转移特点及危险因素分析

目的 研究直肠癌根治术后复发转移特点及其相关危险因素,为术后随访监测、防治复发转移提供依据.方法 回顾性研究中国医学科学院肿瘤医院1999年1月至2004年12月内初次根治手术治疗的1039例直肠癌病例资料,分析术后复发转移的特点及危险因素.结果 随访期间发生复发344例,占33.2％;常见的复发形式依次是局部复发（13.6％）、肝转移（6.9％）、肺转移（6.0％）.单因素分析显示：围手术期输血、病理大体类型、肿瘤大小、肿瘤位置、脉管瘤栓、癌结节、分化程度、T分期、N分期、M分期是复发转移的相关因素（P＜0.05）.多因素分析显示：术前CEA、肿瘤位置、脉管瘤栓、瘤结节、T分期、N分期是复发转移的独立危险因素（P＜0.05）.结论 直肠癌术后存在好发复发转移部位和与复发转移相关的独立危险因素;术后辅助放化疗等多学科综合治疗是降低直肠癌术后复发转移、延长生存期的有效手段.     

T1 adenocarcinoma of the rectum: transanal excision or radical surgery?

Although local excision for rectal cancer has been practiced for more than 120 years, its proper use for the cure of localized rectal cancers is still incompletely understood. The studies on this topic are heterogeneous in terms of selection criteria, surgical approaches and study design. The stage of the disease at the time of diagnosis is the main prognostic factor in rectal cancer. Today the commonly utilized criteria for local excision of rectal cancer are stage T1N0M0, histological grade G1 or G2, and size 3 to 4 cm. Total recurrence rates have been reported to be as low as 0%-4% and as high as 17%-31%. Notwithstanding the differences among the various case series, the risk of recurrence after local excision is real. The evidence seems to point to occult unresected locoregional tumor spread as the major risk factor. We speculate that the combination of unresected occult nodal disease and inadequate adjuvant therapy are two factors that can explain the higher rates of local and distant recurrences. Even radical surgery after the appearance of a recurrence may not be sufficient. When high-risk features are found, patients who return to the operating room immediately for radical surgery have an improved disease-free survival compared to patients who have radical surgery at the time of local recurrence. We conclude that today there is a preference for local excision in older patients in whom radical surgery may be associated with a high risk of complications and death. Local excision in younger and fit patients should be reserved for low-risk cancers in patients who will accept an increased risk of tumor recurrence.     

T2期低位直肠癌术前伊立替康化疗联合短程放疗后局部切除的可行性研究

目的 探讨术前伊立替康化疗联合短程放疗后局部切除术治疗T₂期低位直肠癌的可行性。方法 收集山西省肿瘤医院2002年1月至2008年8月间行术前伊立替康化疗联合短程放疗后行经肛门局部切除术（TAE）的37例低位直肠癌患者的临床资料,分析治疗疗效、不良反应及随访情况。结果 37例患者经术前治疗后4例（10.8％）获完全缓解,27例（73.0％）部分缓解,6例（16.2％）病情稳定,有效率为83.8％,疾病控制率为100.0％。37例患者术后出现肛门狭窄2例（5.4％）,出血和直肠阴道瘘各1例（2.7％）。至随访截止时间,共6例（16.2％）术后出现复发转移,其中3例为局部复发,2例为肝转移,1例局部复发伴肝转移;37例患者术后的3年、5年复发率分别为11.7％、14.1％;全组患者术后生存时间为26～118个月,3例患者因转移复发死亡,术后3年、5年生存率分别为94.6％、91.4％。结论对于符合条件的T₂期低位直肠癌患者,术前伊立替康化疗联合短程放疗后局部切除治疗可以作为临床选择方案之一。     

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.