同时性结直肠癌远处转移的相关临床病理因素分析

目的探讨同时性结直肠癌远处转移的相关临床病理因素。方法收集2056例非连续性结直肠癌病例的临床病理资料,应用logistic回归进行单因素和多因素分析。结果单因素分析显示结直肠癌远处转移与性别、年龄等因素无关(P0.05),与肿瘤部位、肿瘤大体类型、肿瘤最大径、组织类型、病理分级、T分期、N分期、术前CEA水平等因素有关(P0.05);多因素分析显示肿瘤最大径、T分期、N分期、术前CEA水平是影响结直肠癌远处转移的独立因素(P0.05)。结论结直肠癌远处转移与肿瘤最大径、T分期、N分期、术前CEA水平有关。     

240例胃神经内分泌肿瘤的临床病理特征及预后分析

目的探讨胃神经内分泌肿瘤(G⁃NEN)的临床病理特征并分析影响预后的因素。方法采用回顾性病例对照研究方法,分析2000年1月至2018年6月期间在解放军总医院经病理检查并确诊为G⁃NEN患者的临床病理资料,排除合并脏器病变、其他脏器原发性肿瘤、精神疾病及临床病理资料不完整者后,共纳入240例患者的病例资料。采用“胃癌专病数据库系统”进行临床及随访数据资料采集。汇总患者体格检查信息、肿瘤特征和病理特征,并采用Cox回归模型分析影响G⁃NEN患者预后的危险因素。采用Kaplan⁃Meier法绘制生存曲线,并用log⁃rank检验分析组间生存率的差异。结果240例G⁃NEN患者年龄(60.3±10.1)岁,男性181例(75.4%),女性59例(24.6%)。肿瘤直径(4.2±2.8)cm,神经内分泌瘤(NET)51例(21.2%),神经内分泌癌(NEC)139例(57.9%),混合性腺神经内分泌癌(MANEC)50例(20.8%);G1低级别28例(11.7%),G2中级别34例(14.2%),G3高级别178例(74.2%);肿瘤浸润深度T1~4分别为44例(18.3%)、27例(11.2%)、60例(25.0%)和109例(45.4%);163例(67.9%)发生淋巴结转移,46例(19.2%)发生远处转移;Ⅰ~Ⅳ期患者分别为55例(22.9%)、42例(17.5%)、94例(39.2%)和53例(22.1%)。240例G⁃NEN患者中,223例(92.9%)获得随访,中位生存时间为39.2(95%CI:29.1~47.5)个月。单因素分析结果显示,年龄≥60岁、肿瘤直径≥4.2 cm、肿瘤分级为G3、淋巴结转移、远处转移、肿瘤分期(Ⅲ~Ⅳ)均是影响G⁃NEN患者预后的危险因素(均P<0.05);多因素分析结果显示,淋巴结转移(HR=1.783,95%CI:1.007~3.155,P=0.047)和远处转移(HR=2.288,95%CI:1.307~4.008,P=0.004)是影响G⁃NEN患者生存的独立危险因素。进一步亚组分析本组G3高级别G⁃NEN显示,NET⁃G3的5年生存率为76.19%,高于NEC⁃G3和MANEC⁃G3(分别为15.60%和24.73%,P=0.012),差异有统计学意义。结论G⁃NEN患者在诊断时,多已处于进展期,存在淋巴结转移和远处转移提示患者预后较差。高增殖NET⁃G3患者的预后好于NEC⁃G3及MANEC⁃G3,是一类值得进一步关注的分类。     

125例鼻咽癌患者治疗后发生远处转移的临床多因素分析

目的:探讨鼻咽癌患者治疗后发生远处转移的特点和临床影响因素,建立远处转移预测模型,为临床提供参考.方法:2001年5月-2006年5月收治鼻咽癌治疗后0.5年出现远处转移的患者125例,采用Cox回归模型分析远处转移的影响因素,并建立远处转移危险指数(HI)公式,并根据HI值将全部患者分为不同的危险组进行比较.结果:125例中骨转移60例(48.0%),肝转移43例(34.4%),肺转移42例(33.6%),多脏器、多部位转移28例(22.4%),0.5～2年发生远处转移89例(71.2%).单因素分析显示T分期、N分期、临床分期、颈淋巴结转移影响治疗后远处转移(P＜0.01).多因素分析显示N分期、临床分期、有无化疗是鼻咽癌治疗后远处转移的重要影响因素,不同危险组发生远处转移的危险差异有显著性(P＜0.01).结论:大部分鼻咽癌患者发生远处转移在治疗后2年内,常见转移部位是骨、肝、肺.HI值能较好地反映远处转移的危险性.     

肾透明细胞癌淋巴管新生与临床病理因素的关系

目的探讨肾透明细胞癌淋巴管新生与临床病理因素的关系。方法通过免疫组织化学染色方法利用D2-40来标记60例肾透明细胞癌患者标本中的淋巴管,利用光学显微镜测定癌周淋巴管密度(PLVD)并观察癌内淋巴管(ILVs)是否出现,评价PLVD及ILVs与临床病理因素的关系。结果平均PLVD为16.89,按平均值分为两组进行相关性分析表明PLVD与远处转移(P=0.073)、淋巴结转移(P=0.758)、Fuhrman细胞核分级(P=0.866)和肿瘤T分期(P=0.653)无相关性,结果无统计学意义。ILVs的出现与远处转移(P=0.001)、淋巴结转移(P=0.017)及Fuhrman细胞核分级(P=0.002)有相关性,与肿瘤T分期(P=0.570)无相关性。结论 PLVD与临床病理因素包括远处转移、淋巴结转移、Fuhrman细胞核分级及肿瘤T分期无相关性;ILVs的出现与远处转移、淋巴结转移及Fuhrman细胞核分级有显著的相关性。     

乳腺癌患者术后远处转移及其不良结局的危险因素

目的探讨乳腺癌患者术后发生远处转移及其不良结局的危险因素。 方法回顾分析2012年1月至2015年10月期间行手术治疗后发生术后远处转移67例和未发生远处转移130例的女性乳腺癌患者病例资料,随访时间截止2020年10月。采用SPSS 22.0统计软件包分析数据,单因素生存分析采用K-M法,行Log-rank检验;Cox回归模型分析乳腺癌术后转移的多因素分析。 结果脉管状态、组织学分级、肿瘤大小、淋巴结阳性数及化疗方案和靶向治疗是影响乳腺癌术后远处转移的独立危险因素（P<0.05）。67例远处转移患者死亡48例,存活19例,中位生存时间为39个月。多因素分析显示,脉管状态、肿瘤大小、临床分期、组织学分级、转移数目、Her-2状态及化疗方案和靶向治疗是影响远处转移患者预后不良的独立危险因素（P<0.05）。 结论发生脉管癌栓、肿瘤直径越大、临床分期和组织学分级越高、多部位转移、Her-2阳性是影响远处转移患者预后的独立危险因素,术后蒽环类联合紫杉类化疗可以降低远处转移率,提高患者预后。     

Ⅰ_A期乳腺癌临床病理特征及预后相关因素分析

目的:探讨Ⅰ_A期乳腺癌患者的临床病理特征与预后因素。方法:回顾性分析2004年1月—2009年12月天津医科大学肿瘤医院收治的156例IA期(T1N0M0,)乳腺癌患者的临床病理资料。结果:156例患者均为女性;病理类型以浸润性导管癌为主(115例,73.7%);原发肿瘤大小以T1c居多(77例,49.4%);组织学分级以II级(79例,50.6%)及III级(58例,37.2%)为主。5年无进展生存(PFS)为93.3%,5年总生存(OS)为99.1%。单因素分析结果显示,组织学分级、Ki-67表达及淋巴脉管侵犯与患者的PFS有关(均P0.05);多因素分析显示,组织学分级及Ki-67表达情况是影响患者PFS的独立预后因素(均P0.05)。结论:IA期乳腺癌患者虽然总体预后较好,但对于某些亚组患者而言,预后较差,该类患者的复发转移风险较大。     

胃肠胰神经内分泌肿瘤临床特点及预后

目的:研究胃肠胰神经内分泌肿瘤的临床特点及预后。方法:共纳入89例胃肠胰神经内分泌肿瘤(GEP-NENs)患者,观察比较性别、年龄、发病部位、临床症状、病理分型、肿瘤分期等不同因素与预后方面的差异。结果:89例患者中男54例,女35例,平均发病年龄(57.50±11.03)岁,其中最常见好发部位为胃、胰腺、直肠。患者症状多样性,且与原发部位相关。89例GEP-NENs,G_1期患者12例(13.48%),G_2期25例(28.09%),G_3期52例(58.42%)。发生淋巴结转移40例,远处转移12例。手术是其主要治疗方式,同时联合细胞毒性药物治疗和分子靶向药物治疗。单因素分析显示肿瘤分级G_3、肿瘤浸润深度T_4、发生淋巴结转移、发生远处转移为其相关风险因素。结论:GEP-NENs发病率逐年增加,临床表现无特异性,治疗以手术为主,预后与病理分型及肿瘤分期相关。     

上海仁济医院肾癌数据库资料分析

目的 探讨肾癌临床、病理、分期、分级与预后特征. 方法 分析2003年至2005年上海仁济医院泌尿科肾癌数据库435例患者临床和病理资料.采用WHO 1997年肾实质上皮性肿瘤组织学分类标准、2002年ATCC的TNM分期和临床分期、1982年Fuhrman病理分级.采用Kaplan-Meier法和Logrank检验对57例获随访的晚期患者行生存分析和预后因素判断. 结果 435例患者中,遗传性VHL病肾癌10例(2.4%)、散发性肾透明细胞癌372例(85.5%)、乳头状癌13例(3.0%)、嫌色细胞癌18例(4.1%)、集合管癌4例(0.9%)、嗜酸性细胞腺瘤4例(0.9 %)、未分类肾癌.14例(3.2%).行根治性肾切除术335例(77.0%),保留肾单位手术74例(17.0%),姑息性肾切除等手术26例(6.0%).遗传性VHL病肾癌均为双肾癌伴多发囊肿,临床分期Ⅰ期7例、Ⅱ期3例,病理分级Ⅰ级6例、Ⅱ级4例,基因测序均存在VHL基因突变,平均随访28.6个月,患者无肿瘤局部进展或转移,但4例患者出现同侧或双侧肿瘤再发.嫌色细胞癌临床分期均为Ⅰ期,病理分级Ⅰ级5例,Ⅱ级13例,平均随访19.8个月均存活,无肿瘤转移或复发.集合管癌临床分期均为Ⅰ期,病理分级均为Ⅲ级,平均生存时间11.3个月.肾透明细胞癌和乳头状癌临床分期Ⅰ期260例(67.6%)、Ⅱ期64例(16.6%)、Ⅲ期32例(8.3%)、Ⅳ期29例(7.5%),其中T1a 147例(38.2%)、T1b 113例(29.4 %);病理分级Ⅰ级124例(32.2%)、Ⅱ级219例(56.9%)、Ⅲ级40例(10.4%)、Ⅳ级2例(0.5%).57例晚期肾癌患者中位生存时间(16.0±1.3)个月,1年生存率55.0%,2年生存率31.0%.预后因素分析显示,临床分期、肿瘤大小、淋巴结转移、远处转移和病理分级是晚期肾癌解剖水平和组织学水平的预后影响因素. 结论 不同组织学亚型的肾癌生物学特征存在较大差异,遗传性VHL病肾癌存在基因突变,常为双侧、多中心、低Fuhrman分级透明细胞癌,易再发不易转移.肾嫌色细胞癌预后较好,而集合管癌预后差.在解剖水平和组织学水平,TNM分期、肿瘤大小、淋巴结转移、远处转移和肾癌病理分级是晚期肾癌的预后影响因素.     

年轻与老年女性乳腺癌的临床病理比较分析

目的:探讨年轻女性乳腺癌的临床病理特点,为年轻女性乳腺癌的诊治提供依据.方法:对病理组织学确诊的年轻(≤35岁)女性乳腺癌181例及老年(≥60岁)女性乳腺癌186例患者的临床病理资料进行回顾性比较分析.结果:年轻女性乳腺癌患者以31～35岁居多,发病部位左乳多于右乳,2组发病位置均以外上象限居多,多为单发,均以浸润性导管癌为主,年轻组患者的肿瘤大小、组织学分级、TNM分期及腋窝淋巴结转移均明显高于老年组(P<0.05).结论:年轻女性乳腺癌较老年女性乳腺癌侵袭性强,恶性度高.临床应加强对年轻女性乳腺癌的认识和早期诊断.     

IA期乳腺癌临床病理特征及预后相关因素分析

目的：探讨IA期乳腺癌患者的临床病理特征与预后因素。 方法：回顾性分析2004年1月—2009年12月天津医科大学肿瘤医院收治的156例IA期（T1N0M0,）乳腺癌患者的临床病理资料。 结果：156例患者均为女性;病理类型以浸润性导管癌为主（115例,73.7%）;原发肿瘤大小以T1c居多 （77例,49.4%）;组织学分级以II级（79例,50.6%）及III级（58例,37.2%）为主。5年无进展生存（PFS）为93.3%,5年总生存（OS）为99.1%。单因素分析结果显示,组织学分级、Ki-67表达及淋巴脉管侵犯与患者的PFS有关（均P<0.05）;多因素分析显示,组织学分级及Ki-67表达情况是影响患者PFS的独立预后因素（均P<0.05）。 结论：IA期乳腺癌患者虽然总体预后较好,但对于某些亚组患者而言,预后较差,该类患者的复发转移风险较大。     

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。     

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.     

Lymph Node Status in Patients with Submucosal Gastric Cancer

Background The aim of this study was to clarify the lymph node status in patients with submucosal gastric cancer.Methods Between April 1994 and December 1999, 615 patients with histologically proven submucosal gastric cancer who underwent curative resection were included in this study. The results of the surgery and predictive factors for lymph node metastasis were evaluated by univariate and multivariate analyses. The accuracy of the predictive factors was assessed in a second population of a further 186 patients.Results Lymph node metastasis was observed in 119 patients (19.3%). Multivariate analysis showed that pathologic tumor diameter (≥20 mm) and lymphatic invasion were independent predictive factors for lymph node metastasis. The incidence of lymph node metastasis without these 2 predictive factors was 1.8% (2 of 113), and it was 51.2% (85 of 166) with the 2 predictive factors, 9.5% (14 of 148) in tumors <20 mm in diameter, and 5.3% (22 of 414) in tumors without lymphatic invasion. Among patients with a tumor <20 mm in diameter, the incidence of lymph node metastasis was significantly reduced in those with a differentiated tumor: 4.2% (4 of 95). These results were almost identical to those observed in the second population.Conclusions Lymph node status can be accurately predicted on the basis of pathologic tumor diameter <20 mm, lymphatic invasion (absence), and histological type (differentiated) in patients with submucosal gastric cancer. Less extensive surgery for these patients might be reconsidered after confirmation of the reproducibility of the results of this study by an appropriately designed prospective clinical trial.     

胃黏膜下层癌淋巴结转移临床病理因素分析

【摘要】 目的 研究胃黏膜下层癌淋巴结转移率及其影响因素。 方法 回顾性分析南京医科大学第一附属医院1998年1月至2007年12月手术证实的181例胃黏膜下层癌的临床病理资料,对病人年龄、性别、肿瘤组织学类型、形态学类型、大小、部位、浸润深度、脉管内癌栓等与淋巴结转移的关系进行单因素与多因素分析。 结果 胃黏膜下层癌淋巴结转移率为20.44%。影响胃黏膜下层癌淋巴结转移的因素主要有肿瘤组织学类型（分化型 vs 分化不良型,P =0.0352）、直径大小（＜2cm vs ≥2cm,P =0.0143）、部位（近端胃vs胃体vs远端胃,P =0.0254）及脉管内癌栓（无vs有,P =0.0323）。Logistic回归分析显示肿瘤组织学类型与大小为胃黏膜下层癌淋巴结转移的独立性危险因素。结论 胃黏膜下层癌淋巴结转移与肿瘤组织学类型、大小、部位及脉管内癌栓等因素有关。临床上应参考上述临床病理因素判断淋巴结转移风险,制定合适的治疗方案。     

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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.     

Prediction of Mediastinal Lymph Node Metastasis in Papillary Thyroid Cancer

Because of the rarity of mediastinal lymph node metastasis, no evidence exists regarding risk factors indicating its presence. This study aimed to identify risk factors representing potential triggers of imaging for mediastinal lymph node metastasis. Carried out was an analysis of 392 consecutive patients with node-positive papillary thyroid cancer referred to a tertiary surgical center. Significant univariate associations (P ≤ 0.001) existed, after correction for multiple testing, between mediastinal lymph node metastasis and poor tumor differentiation (24% versus 2%), number of positive lymph nodes (mean 14.4 versus 7.3 nodes), and distant metastasis (43% versus 11%). Only nominally significant were age at first tumor diagnosis (47.7 versus 39.1 years; P = 0.042), extrathyroidal tumor extension (76% versus 53%; P = 0.044), and bilateral lymph node metastasis (81% versus 49%; P = 0.006). In the initial and optimized multivariate logistic regression models, which included all significant variables from the above analysis, only poor tumor differentiation (odds ratio 11.6–14.6) and distant metastasis (odds ratio 5.4–6.1) represented significant (P ≤ 0.005) predictors of mediastinal lymph node metastasis. These two variables featured excellent negative predictive values of 96%. Regarding prediction of mediastinal lymph node metastasis, poor tumor differentiation was more discriminatory than distant metastasis, as reflected in a better accuracy (94% versus 86%) and positive predictive value (42% versus 18%). We conclude that, subject to validation in independent series, patients with poorly differentiated papillary thyroid cancers, which are rare, should be ideal candidates for mediastinal imaging because 5 of 12 patients (42%) having this condition in the present investigation harbored mediastinal lymph node metastasis.     

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。     

肝细胞癌临床病理学特征与手术后长期存活的多因素相关分析

目的评估肝细胞癌（hepatocellular carcinoma，HCC）病理学特征对于长期存活的影响。方法选取1991年1月至2002年6月西南医院实施根治性肝切除，具有完整随访资料和临床资料234例HCC，应用COX比例风险模型单因素和多因素分析影响预后的病理因素，寿命表法计算生存率，Kaplan-Meier乘积极限法绘制生存曲线，log-rank Χ^2检验比较生存时间差异。结果单因素分析提示影响HCC预后的病理因素包括肿瘤大小、微血管侵犯、大血管侵犯、淋巴结侵犯、邻近器官侵犯和Edmonson-Steiner分级，多因素分析发现大血管侵犯（RR：1．728，P〈0．05）、微血管侵犯（RR：1．476，P〈0．05）、淋巴结侵犯（RR：5．010，P〈0．01）、邻近器官侵犯（RR：1．695，P〈0．05）是独立影响HCC预后的重要病理因素。结论大血管侵犯、微血管侵犯、淋巴结侵犯、邻近器官侵犯是影响HCC预后的重要病理学因素。     

早期胃癌淋巴结转移潜在危险因素分析

目的:探讨影响早期胃癌淋巴结转移的潜在危险因素,指导胃癌淋巴结清扫术(D1或D2)的合理应用。方法:回顾性分析1995年3月—2010年6月经手术治疗的336例早期胃癌患者的临床病理资料,对影响早期胃癌淋巴结转移的潜在危险因素进行单因素及多因素分析。结果:早期胃癌淋巴结转移与性别(P=0.010)、年龄(P=0.013)、肿瘤部位(P=0.042)、有无合并溃疡(P=0.001)、浸润深度(P<0.0001)、有无脉管癌栓(P<0.0001)有关,合并有溃疡(P=0.012)、浸润至黏膜下层(P=0.008)及有脉管癌栓(P=0.001)是淋巴结转移的独立性危险因素;黏膜内癌淋巴结转移与肿瘤部位(P=0.007)及大小(P=0.010)有关,肿瘤直径>20mm(P=0.041)是黏膜内癌淋巴结转移的独立性危险因素。结论:合并有溃疡、浸润至黏膜下层及有脉管癌栓的早期胃癌患者进行手术时,建议行淋巴结清扫(D2)术;肿瘤直径>20mm黏膜内癌也要考虑行淋巴结清扫(D2)术。     

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.