Zhao Dong-bing, Gao Ji-dong, Bi Jian-jun, Shao Yong-fu, Zhao Ping
Department of Abdominal Surgical Oncology, Cancer Institute (Hospital), Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
Zhonghua Zhong Liu Za Zhi. 2006 Mar;28(3):235-7.
To investigate the characteristics of lymph node metastasis and prognosis of T1/T2 rectal carcinoma.
The clinical data of 241 patients with T1 or T2 rectal carcinoma were retrospectively analyzed. The factors relative to lymph node metastasis were analyzed using Chi-square test. The survival data were analyzed using Kaplan-Meier method. The factors influencing survival were analyzed using univariate (Long-rank) and multivariate (Cox model) methods.
Of the 241 patients, 132 received Mile's operation and 109 underwent sphincter preserving operation. The over-all lymph node metastasis rate was 22.0% (53/241). The lymph node metastasis was significantly correlated with histological differentiation as revealed by Chi-square test. The over-all 5-year survival rate for the whole series group was 91.5%. Univariate analysis revealed that tumor histological type, intramural infiltration, differentiation, lymph node metastasis, radiation therapy were significant predictors of survival; however, only intramural infiltration was the most important prognostic predictor by multivariate analysis.
Even though lymph node metastasis can be observed either in T1 or T2 rectal carcinoma, histological differentiation is significantly related to the lymph node metastasis. As radical resection achieve better survival than local resection, it should be suggested as the chief treatment for T1/T2 rectal carcinoma.
探讨T1/T2期直肠癌淋巴结转移特征及预后情况。
回顾性分析241例T1或T2期直肠癌患者的临床资料。采用卡方检验分析与淋巴结转移相关的因素。采用Kaplan-Meier法分析生存数据。采用单因素(长秩检验)和多因素(Cox模型)方法分析影响生存的因素。
241例患者中,132例行腹会阴联合直肠癌根治术(Mile's手术),109例行保肛手术。总体淋巴结转移率为22.0%(53/241)。卡方检验显示淋巴结转移与组织学分化显著相关。整个系列组的总体5年生存率为91.5%。单因素分析显示,肿瘤组织学类型、壁内浸润、分化程度、淋巴结转移、放疗是生存的重要预测因素;然而,多因素分析显示只有壁内浸润是最重要的预后预测因素。
尽管T1或T2期直肠癌均可出现淋巴结转移,但组织学分化与淋巴结转移显著相关。由于根治性切除比局部切除有更好的生存率,故建议将根治性切除作为T1/T2期直肠癌的主要治疗方法。