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。

Factors affecting the prognosis and selection of local excision for low rectal cancer

OBJECTIVE: To investigate the factors affecting the result and selection of local excision for low rectal cancer. METHODS: The clinical data of 101 patients with low rectal cancer treated by local excision were retrospectively analyzed. Survival was estimated using the Kaplan-Meier. The factors influencing on the survival were analyzed using univariate (Log rank) and multivariate (Cox model) analysis methods. RESULTS: Of 101 patients in this series, 91 patients underwent transanal excision, 9 had transsacral excision, 1 recieved transvaginal excision. Postopertative complication developed in 6 patients (5.9%). No death occurred within 30 postoperative days. Five T4 patients underwent preoperative radiotherapy, and 34 received postoperative radiotherapy. The overall 5-year survival rate was 91.0% for the whole group, and it was 100%, 92.6%, 77.1%, 83.3% for patients with Tis, T1, T2, and T3/T4 lesion, respectively. The incidence of local recurrence was 15. 8%. Univariate analysis revealed that pathological T stage, tumor size (> 3 cm), lymphovascular invasion, ulcerative lesion, adjuvant radiotherapy and local recurrence were significant factors affecting the survival (P <0.05). However, by multivariate analysis, only tumor size ( > 3 cm) and local recurrence were found to be the significant prognostic predictors. CONCLUSION: The important selection criteria for local excision in the treatment of low rectal cancer may include T1 stage, well or moderate differentiation,tumor size < or = 3 cm, no lymphovascular invasion.