【摘要】 背景与目的:全直肠系膜切除术(total mesorectal excision,TME)能够显著降低直肠癌的局部复发率,改善患者预后。本研究回顾性分析1056例行根治性TME术的直肠癌病例的临床病理特征及其与预后的关系。方法:收集1990-2003年接受根治性TME术的1056例直肠癌的病例资料,建立数据库。用单因素分析和多因素分析的方法研究20项临床病理指标对接受根治性TME术的直肠癌患者预后的影响。结果:本组总体的3年、5年及10年生存率分别为84.9%(95%CI,83.8%～86.0%)、73.8%(95%CI,72.4%～75.2%)及65.1%(95%CI,63.4%～66.8%)。单因素分析显示,术前血清CEA水平和CA19-9水平、术前合并肠梗阻或穿孔、肿瘤大体类型、肿瘤组织类型、病理分级、肠壁浸润深度、淋巴结转移情况以及初治时间是直肠癌患者TME术后预后的影响因子。Cox比例危险回归模型多因素分析显示,淋巴结转移情况、组织类型、手术方式以及浸润深度是预后的独立影响因素。结论:淋巴结转移情况、组织类型、手术方式以及肠壁浸润深度可作为判断直肠癌患者预后的参考指标。更多还原

【Abstract】 Background and Objective:Total mesorectal excision(TME) can reduce local recurrence and improve prognosis of rectal cancer.This study was to analyze the clinicopathologic characteristics of rectal cancer , and explore the prognosis factors of rectal cancer after radical TME.Methods:From 1990 to 2003, 1056 rectal cancer patients had received radical TME.The impacts of 20 clinicopathologic factors on the prognosis were analyzed with univariate and multivariate method.Results:The 3-, 5-, and 10-year overall survival rates were 84.9%(95% CI, 83.8%-86.0%), 73.8%(95% CI, 72.4%-75.2%), and 65.1%(95% CI, 63.4%-66.8%), respectively.Univariate analysis showed that preoperative serum carcinoembryonic antigen(CEA) and CA19-9 levels, tumor gross type, pathologic type, pathologic grade, preoperative bowel obstruction or bowel perforation, T stage, N stage, and first treatment era were associated with the prognosis of rectal cancer.Multivariate analysis showed that N stage, histological type, surgical procedures, and T stage were independent prognostic factors.Conclusion:N stage, histological type, surgical procedures, and T stage are independent prognostic factors for rectal cancer patients who received radical TME.更多还原