低位直肠癌不良预后的危险因素。
Risk factors for adverse outcome in low rectal cancer.
机构信息
Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, Guangdong Province, China.
出版信息
World J Gastroenterol. 2012 Jan 7;18(1):64-9. doi: 10.3748/wjg.v18.i1.64.
AIM
To demonstrate the oncologic outcomes of low rectal cancer and to clarify the risk factors for survival, focusing particularly on the type of surgery performed.
METHODS
Data from patients with low rectal carcinomas who underwent surgery, either sphincter-preserving surgery (SPS) or abdominoperineal resection (APR), at The First Affiliated Hospital of Sun Yat-sen University in China from August 1994 to December 2005 were retrospectively analyzed.
RESULTS
Of 331 patients with low rectal cancer, 159 (48.0%) were treated with SPS. A higher incidence of positive resection margins and a higher 5-year cumulative local recurrence rate (14.7% vs 6.8%, P = 0.041) were observed in patients after APR compared to SPS. The five-year overall survival (OS) was 54.6% after APR and 66.8% after SPS (P = 0.018), and the 5-year disease-free survival (DFS) was 52.9% after APR and 65.5% after SPS (P = 0.013). In multivariate analysis, poor OS and DFS were significantly related to positive resection margins, pT3-4, and pTNM III-IV but not to the type of surgery.
CONCLUSION
Despite a higher rate of positive resection margins after APR, the type of surgery was not identified as an independent risk factor for survival.
目的
展示低位直肠癌的肿瘤学结果，并阐明生存的风险因素，重点关注所行手术的类型。
方法
回顾性分析了 1994 年 8 月至 2005 年 12 月在中国中山大学附属第一医院接受手术治疗的低位直肠癌患者的数据，手术方式为保肛手术（SPS）或腹会阴切除术（APR）。
结果
在 331 例低位直肠癌患者中，有 159 例（48.0%）接受了 SPS 治疗。与 SPS 相比，APR 组的阳性切缘发生率和 5 年累积局部复发率更高（14.7%比 6.8%，P=0.041）。APR 组的 5 年总生存率（OS）为 54.6%，SPS 组为 66.8%（P=0.018），APR 组的 5 年无病生存率（DFS）为 52.9%，SPS 组为 65.5%（P=0.013）。多因素分析显示，阳性切缘、pT3-4 和 pTNM III-IV 与较差的 OS 和 DFS 显著相关，但与手术类型无关。
结论
尽管 APR 后阳性切缘的发生率较高，但手术类型并不是生存的独立危险因素。
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