病理高危因素对I期直肠癌患者预后的影响

目的探讨病理高危因素与I期直肠癌预后的关系，从而为临床提供有益的指导。 方法回顾性分析2011年1月至2013年1月期间在哈尔滨医科大学附属第二医院结直肠肿瘤外科接受根治性手术治疗且术后病理回报为I期的直肠癌患者178例，分为有高危因素组和无高危因素组，有高危因素的患者119例，男性60例，女性59例；无高危因素的患者59例，男性33例，女性26例。中位随访时间为33个月，并详细记录患者的无病生存期。 结果2组患者在性别、年龄、大体类型、分化类型、淋巴结检出数目、浸润深度、肿瘤部位等方面比较差异无统计学意义（χ²=0.480，t=2.023，χ²=2.244，χ²=5.614，t=2.387，χ²=1.590，χ²=3.099，P均>0.05），2组术后随访时间相同，无高危因素组患者预后良好无复发及远处转移，而有高危因素组中出现了局部复发和远处转移的病例。有和无高危因素的I期直肠癌患者的无病生存期差异存在统计学意义（HR=0.86，95%CI 0.56~0.97）。淋巴管浸润、脉管瘤栓、神经侵犯及低分化是影响患者无病生存期的主要因素。 结论对于含有病理高危因素的I期直肠癌患者应进行密切随访观察。

Pathological risk factors affect the prognosis of patients with stage I rectal cancer

ObjectiveTo investigate the effect of pathology risk factors on prognosis of stage I rectal cancer patients. MethodsData of patients with stage I rectal cance from January 2011 to January 2013 in the 2nd Affiliated Hospital of Harbin Medical University were retrospectively collected. 178 cases were included and were divided into two groups according to the presence of high risk pathological factors. 119 cases were defined as high-risk group including 60 males and 59 females, and 59 cases were in non high-risk group, the male cases were 33 and females were 26 respectively. Median follow-up time was 33 months. ResultsThere were no difference in the sex, age, macroscopic type, differentiation, numbers of lymph node, depth of invasion and location (χ²=0.480, t=2.023, χ²=2.244, χ²=5.614, t=2.387, χ²=1.590, χ²=3.099, all P values >0.05) . No recurrence and metastasis were observed in non-high-risk group while local recurrence and metastasis were observed in high-risk group. There was difference in survival time between two groups (HR=0.86, 95%CI 0.56~0.97). Lymph vascular infiltration, nervous invasion and low differentiation were the main factors that affected survival. ConclusionClosely follow up should be performed on the high-risk stage I rectal cancer patients.