影响中下段直肠癌患者根治术后生存的多因素分析

背景与目的：中下段直肠癌在我国发生率较高,如何提高中下段直肠癌治疗效果的研究一直受到关注。本研究旨在探讨中下段直肠癌患者根治术后临床及病理特征与预后的关系。方法：回顾性分析中山大学肿瘤防治中心1990年～1999年收治的599例中下段直肠癌患者的临床及病理资料。全组患者中行经腹会阴联合切除术（abdominoperineal resection,APR）355例,低位前切除术（low anterior resection,LAR）244例。采用寿命表法计算生存率,log-rank检验进行生存曲线比较,应用Cox比例风险模型进行多因素分析。结果：全组总的5年生存率为70．7％,其中APR与LAR依次为：67．5％、75．2％（P=0．026）。单因素分析显示,局部复发、围手术期输血、T分期、淋巴结转移、手术方式、肿瘤大体类型、组织类型以及肿瘤距肛缘长度与中下段直肠癌患者预后相关（P〈0．05）。多因素分析显示。局部复发、围手术期输血、T分期和淋巴结转移是影响预后的独立因素（P〈0．01）。结论：局部复发、围手术期输血、T分期和淋巴结转移是影响中下段直肠癌患者预后重要的指标。LAR正逐渐成为中下段直肠癌根治术首选的手术方式之一。

Multivariate prognostic analysis of patients with low and middle rectal cancer after curative resection

BACKGROUND & OBJECTIVE: The incidence of low and middle rectal cancer is high in China. Researches on improving treatment efficacy of this disease have constantly been concerned. This study was to evaluate the correlation of clinicopathologic features to the prognosis in low and middle rectal cancer. METHODS: The clinicopathologic data of 599 patients with low and middle rectal cancer, treated from 1990 to 1999 in Cancer Center of Sun Yat-sen University, were analyzed retrospectively. Curative resection was performed for all patients, including abdominoperineal resection (ARP, 355 cases) and low anterior resection (LAR, 244 cases). Survival rate was calculated using life table method, and differences between survival curves were tested by log-rank test. Cox regression model was used for multivariate prognostic analysis. RESULTS: The overall 5-year survival rate was 70.7%; it was significantly lower in APR group than in LAR group (67.5% vs. 75.2%, P=0.026). Univariate analysis showed that local recurrence, perioperative blood transfusion, lymph node metastasis, T stage, histology, macropathology, operation pattern, and distance from anal margin were correlated to prognosis (P<0.05). Multivariate analysis showed that local recurrence, perioperative blood transfusion, lymph node metastasis, and T stage were independent prognostic factors (P<0.01). CONCLUSIONS: Local recurrence, perioperative blood transfusion, lymph node metastasis, and T stage are important prognostic factors of low and middle rectal cancer. LAR has become the preferred option in curative surgery for low and middle rectal cancer.