Huguier M, Depoux F, Houry S, Mauban S
Department of Digestive Surgery, Hôpital Tenon, Paris, France.
Int J Colorectal Dis. 1990 Aug;5(3):144-7. doi: 10.1007/BF00300404.
The aims of this study were to describe the results of 100 consecutive abdominoperineal excisions, and to try to define homogeneous subgroups of survivors using the Cox regression analysis model. There was one postoperative death. No patient was lost to follow-up. Overall 5-year survival rate was 45%. Multivariate analysis selected 3 prognostic factors: lymph node involvement (p less than 0.001), local tumour extent (P = 0.08), and extension to adjacent organs (p = 0.03). Four subgroups of patients were defined. Best survival was observed in patients (n = 43) with tumour invading into the subserosa (W1) or less and without lymph node metastasis (N0), with a 5-year survival of 82% (group 1). Patients in Group 2 (n = 18) had a tumour invading into the muscularis propria or less with lymph node metastasis (W0 N+), or into the serosa or perirectal fat without lymph node invasion (W2 N0), with a 5-year survival of 51%. Patients in Group 3 (n = 17) had a tumour invading into the subserosa with lymph node invasion (W1 N+) or extension to adjacent organ without lymph node invasion (W3 N0) with a 5-year survival of 24%. Patients in group 4 (n = 22) had extension into the serosa or perirectal fat or more with lymph node invasion (W2 N+) with a 5-year survival of 2%. This scoring system is simple, practical and easy to apply. If it can be confirmed by other studies, its routine adoption could be justified.
本研究的目的是描述连续100例腹会阴联合切除术的结果，并尝试使用Cox回归分析模型确定存活者的同质亚组。术后有1例死亡。无患者失访。总体5年生存率为45%。多因素分析选择了3个预后因素：淋巴结受累（p<0.001）、局部肿瘤范围（P = 0.08）和侵犯相邻器官（p = 0.03）。定义了4个患者亚组。肿瘤侵犯至浆膜下层（W1）或更浅且无淋巴结转移（N0）的患者（n = 43）生存率最佳，5年生存率为82%（第1组）。第2组（n = 18）患者的肿瘤侵犯至固有肌层或更浅且有淋巴结转移（W0 N+），或侵犯至浆膜或直肠周围脂肪但无淋巴结侵犯（W2 N0），5年生存率为51%。第3组（n = 17）患者的肿瘤侵犯至浆膜下层且有淋巴结侵犯（W1 N+）或侵犯相邻器官但无淋巴结侵犯（W3 N0），5年生存率为24%。第4组（n = 22）患者的肿瘤侵犯至浆膜或直肠周围脂肪或更深且有淋巴结侵犯（W2 N+），5年生存率为2%。该评分系统简单、实用且易于应用。如果能得到其他研究的证实，则有理由常规采用。
