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早期直肠癌行标准切除术与局部切除术的长期疗效。

Long-term outcome of early-stage rectal cancer undergoing standard resection and local excision.

机构信息

Department of Colorectal Surgery, Cancer Hospital Fudan University, Department of Oncology, Shanghai Medical College, Fudan University, People's Republic of China.

出版信息

Clin Colorectal Cancer. 2011 Mar 1;10(1):37-41. doi: 10.3816/CCC.2011.n.005.

Abstract

OBJECTIVES

To explore the long-term outcome and prognostic factors for early stage rectal cancer patients undergoing standard resection (SR) or local excision (LE).

PATIENTS AND METHODS

This study included 350 patients with stage I rectal cancer, in which 283 cases (80.9%) received SR, and 67 cases (19.1%) received LE. Survival analyses were performed to compare outcomes of different surgeries.

RESULTS

The 5-year local recurrence (LR) rate was 14.1% in LE group versus 3.3% in SR group (P= .0004), and the 10-year overall survival (OS) rate was not significantly different between the 2 groups. Multivariate analysis suggested that LE was an independent risk factor for 5-year LR rate and 10-year OS rate. Tumor grade was found related to 5-year LR, and T stage was found related to 10-year OS. Tumor size of 2.5 cm is found as a possible cut-off for predicting 5-year LR rate in LE group, with a sensitivity of 77.8% and a specificity of 75.9%. In patients with LE, the 5-year LR rate for tumors ≥ 2.5 cm was 40%, compared with 4.3% for tumors < 2.5 cm (P = .001).

CONCLUSION

Local excision in early-stage rectal cancer may result in high local recurrence rate. The procedure is only recommended in highly selective groups of patients. A tumor size of 2.5 cm is a useful criterion for choosing LE rather than SR.

摘要

目的

探索行标准切除术(SR)或局部切除术(LE)的早期直肠癌患者的长期预后及相关因素。

患者和方法

本研究纳入了 350 例 I 期直肠癌患者,其中 283 例(80.9%)接受了 SR,67 例(19.1%)接受了 LE。生存分析用于比较不同手术的结果。

结果

LE 组的 5 年局部复发(LR)率为 14.1%,而 SR 组为 3.3%(P=.0004),两组 10 年总生存率(OS)无显著差异。多因素分析表明,LE 是 5 年 LR 率和 10 年 OS 率的独立危险因素。肿瘤分级与 5 年 LR 相关,T 分期与 10 年 OS 相关。肿瘤大小 2.5cm 可能是 LE 预测 5 年 LR 率的一个临界点,其敏感性为 77.8%,特异性为 75.9%。在 LE 患者中,肿瘤≥2.5cm 的 5 年 LR 率为 40%,而肿瘤<2.5cm 的 LR 率为 4.3%(P=.001)。

结论

早期直肠癌的局部切除可能导致较高的局部复发率。该手术仅推荐用于高度选择的患者群体。肿瘤大小 2.5cm 是选择 LE 而非 SR 的一个有用标准。

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