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[结肠腺癌的生存及预后因素:150例病例的多因素分析回顾]

[Survival and prognostic factors of colorectal adenocarcinoma: analytic multifactor review of 150 cases].

作者信息

Arfa N, Hamdani I, Gharbi L, Ben Abid S, Ghariani B, Mannai S, Mestiri H, Khalfallah M T, Mzabi S R

机构信息

Service de Chirurgie Générale, Hôpital Mongi-Slim, Sidi-Daoued, La-Marsa 2045, Tunis, Tunisie.

出版信息

Ann Chir. 2006 Feb;131(2):104-11. doi: 10.1016/j.anchir.2005.12.012. Epub 2006 Jan 19.

Abstract

INTRODUCTION

Prognostic factors have a pivotal role in clinical oncology. They are helpful in the selection of treatment; provide insights into the disease process and the therapic response. The number of possibility useful prognosis factors in the colorectal cancer is large. This study attempts to observe the survival of colorectal adenocarcinoma and to find prognostic factors and other variables potentially associated with outcome of colorectal adenocarcinoma.

MATERIAL AND METHODS

It's a retrospective study based on 150 patients with colorectal adenocarcinoma from 1990 to 2002. There were 150 patients aged of 58 years (median 61 years) with 1.4 sex-ratio. 84 patients had colon adenocarcinoma and 66 patients had rectal adenocarcinoma. In histological exam the adenocarcinoma was well differenced in 69 cases (46%), and undifferentiated in 17 cases (18, 3%).

RESULTS

Locoregional extension was found in 18 cases and metastatic extension in 45 cases with hepatic metastasis in 37 cases and pulmonary metastasis in 8 cases. There were 6 cases of peritoneal localized carcinosis and 6 cases of ovary metastasis. There were 6 patients (4%) Dukes stage I TNM, 61 stage II (40, 7%), 51 stage III TNM (34%) and 32 patients stage IV TNM (34%). All patients had surgical curative resection associated with adjuvant chemotherapy in 60 cases of colon adenocarcinoma and preoperative radiotherapy in 33 cases of rectal adenocarcinoma. After a follow up of 46 months, 52 patients was died (10 operative mortality), 35 patients were lost of view and 63 patients were still alive at the point date. Median survival was 20 months with 95% confidence interval: (4, 2-7, 8). Overall one year and 5 years survival were respectively 92,8% and 26,3%. Various prognostic factors had been identified through univariate (Kaplan-Meier) then multivariate (Cox) analyze. In addition to the clinical factors, we found of significant prognostic value undifferentiated adenocarcinoma and an elevated value of serum carcinoembryonic antigen>5 ng/ml.

摘要

引言

预后因素在临床肿瘤学中起着关键作用。它们有助于治疗方案的选择;能深入了解疾病进程和治疗反应。结直肠癌中可能有用的预后因素数量众多。本研究旨在观察结直肠腺癌的生存率,并寻找预后因素以及其他可能与结直肠腺癌预后相关的变量。

材料与方法

这是一项基于1990年至2002年150例结直肠腺癌患者的回顾性研究。150例患者年龄为58岁(中位数61岁),男女比例为1.4。84例患有结肠腺癌,66例患有直肠腺癌。组织学检查中,69例(46%)腺癌分化良好,17例(18.3%)未分化。

结果

发现18例有局部区域扩展,45例有转移扩展,其中37例有肝转移,8例有肺转移。有6例腹膜局限性癌和6例卵巢转移。有6例(4%)患者为Dukes I期TNM,61例为II期(40.7%),51例为III期TNM(34%),32例为IV期TNM(34%)。所有患者均接受了手术根治性切除,60例结肠腺癌患者接受了辅助化疗,33例直肠腺癌患者接受了术前放疗。随访46个月后,52例患者死亡(10例手术死亡率),35例失访,63例在随访时仍存活。中位生存期为20个月,95%置信区间为(4.2 - 7.8)。总体1年和5年生存率分别为92.8%和26.3%。通过单因素(Kaplan-Meier)然后多因素(Cox)分析确定了各种预后因素。除了临床因素外,我们发现未分化腺癌和血清癌胚抗原>5 ng/ml的升高值具有显著的预后价值。

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