【作者】 张钊；

【导师】 汤文浩；

【作者基本信息】 东南大学 ， 临床医学（专业学位）， 2016， 硕士

【摘要】 研究目的：了解我院不同部位结直肠癌的构成分布及变化趋势,比较不同解剖部位结直肠癌的临床病理特征,为正确认识和掌握右半结肠癌、左半结肠癌与直肠癌提供依据,也为进一步研究结直肠癌的发病机制及其诊断和治疗打下基础。研究方法：回顾2006年～2015年期间东南大学附属中大医院普外科收治的1024例结直肠癌患者的临床和病理资料,分析比较不同解剖部位结直肠癌的临床病理特征。并与国内外同类资料进行比较讨论。研究结果：1.在本研究的全部结直肠癌中,右半结肠癌(33.0%)、左半结肠癌(28.6%)和直肠癌(38.4%)的构成比基本相当。左半结肠癌近4年来年度构成比略呈上升趋势。2.无论是在右半结肠癌、在左半结肠癌还是在直肠癌,老年病人的构成比都高于中年病人的构成比,中年病人的构成比都高于青年病人的构成比。三组不同部位结直肠癌的发病年龄构成有显著差异(P=0.007<0.01)。组间比较发现,在发病年龄构成上,右半结肠癌组与左半结肠癌组无明显差异(P=0.714),右半结肠癌组与直肠癌组有显著差异(P=0.003<0.01),左半结肠癌组与直肠癌组有差异(P=0.045<0.05)。其中直肠癌的青年病人构成比(6.9%)高于右半结肠癌(3.8%)和左半结肠癌(4.8%),直肠癌的中年病人构成比(28.2%)也高于右半结肠癌(19.8%)和左半结肠癌(21.5%),而直肠癌的老年病人构成比(64.9%)低于右半结肠癌(76.4%)和左半结肠癌(73.7%)。3.无论是在右半结肠癌、在左半结肠癌还是在直肠癌,都是男性病人多于女性。三组不同部位结直肠癌的性别构成有显著差异(P=0.001<0.01)。右半结肠癌的女性构成比(47.9%)高于左半结肠癌(33.8%)和直肠癌(39.2%)。4.病理类型、肿瘤分化程度及TNM分期在三组不同部位结直肠癌之间均有显著差异(P<0.01)。右半结肠粘液腺癌的构成比高于左半结肠和直肠,右半结肠腺癌的构成比低于左半结肠和直肠。右半结肠低分化癌的构成比高于左半结肠和直肠,而右半结肠高分化癌的构成比低于左半结肠癌和直肠。直肠癌Ⅰ期的病人构成比高于右半结肠癌和左半结肠癌,直肠癌Ⅱ期的病人构成比低于右半结肠癌和左半结肠癌。5.在结直肠癌中CEA阳性率为30.3%,CA19-9阳性率为12.3%。CEA阳性率和CA19-9阳性率在不同部位结直肠癌之间无明显差异。但低分化癌中的CEA阳性率和CA19-9阳性率均高于中分化癌和高分化癌,腺癌中的CA19-9阳性率显著低于粘液腺癌和其他癌。p53、hMLH1、hMSH2和COX2在结直肠癌中的表达率高,均超过75%,但在不同部位结直肠癌之间无统计学差异,只有hMLH1在右半结肠癌中的表达率低于左半结肠和直肠。结论：1.我院10年来结直肠癌无明显“右移现象”。近4年左半结肠癌构成比略呈上升趋势,应重视左半结肠癌的早期诊疗。2.老年病人易患结肠癌特别是右半结肠癌,而在中青年病人中,直肠癌更多见。结直肠癌中男性病人多于女性,女性易患右半结肠癌。而右半结肠癌分化差、TNM分期晚,粘液腺癌更多见,预后差。术前CEA阳性率、CA19-9阳性率越高,结直肠癌的预后越差。3. hMLH1在右半结肠癌中的表达率低,表明右半结肠癌更多的是MSI阳性肿瘤。更多还原

【Abstract】 Objectives:Understand the composition and the changing of colorectal cancer in different anatomic subsite, compare the clinical, pathological and biochemical features, to correctly understand and grasp the differences in right-sided colon cancer, left-sided colon cancer and rectal cancer. Lay a foundation to further study about the pathogenesis and its diagnosis and treatment of colorectal cancer.Methods:Retrospectively collected the clinicopathological characteristics data of 1024 colorectal cancer patients with complete data in Zhongda hospital of Southeast university from January 2006 to December 2015, analyzing and comparing clinicopathological characteristics of colorectal cancer in different anatomic subsite. Discussing and comparing the results with similar materials at home and abroad.Results:1. The right-sided colon cancer, the left-sided colon cancer and rectal cancer have the similar component ratio. Left-sided colon cancer in recent 4 years has annually rising.2. The component ratio of elderly patients is higher than the middle-aged, and the component ratio of middle-aged patients is higher than the young. The component of age is significantly different in three groups (P= 0.007< 0.05).Colorectal cancer group of young and middle-aged patients constitute a ratio higher than that of colon cancer, while the colon cancer component ratio is higher than that of rectal cancer in elderly patients.3. Male with colorectal cancer is more than female, and the component of gender has a significant difference in three groups (P= 0.001< 0.05). The female right-sided colon cancer (15.8%) is higher than the female left-side colon cancer (9.7%) (P=0.000<0.05). While the male right-sided colon cancer (17.2%) is lower than the male rectal cancer (23.3%) (P=0.017<0.05).4. The histological type (P=0.000<0.05), the differentiation degree (P=0.002<0.05) and stage (P= 0.000<0.05) are significantly different in three groups. The right colon mucous adenocarcinoma is higher than the left colon and rectal. The right colon adenocarcinoma is obvious lower than the rectal. The right colon poorly differentiated carcinoma is obvious higher than the left colon and rectal. The stage I rectal cancer is higher than the that in right-sided and left-sided colon.5. The CEA positive rate is 30.3% and the CA19-9 positive rate is 12.3%. CEA positive rate (P=0.909) and CA19-9 positive rate (P=0.400) have no statistically significant difference in three groups. But the poorly differentiated colorectal cancer has the higher CEA positive rate and CA19-9 high positive rate, colorectal mucous adenocarcinoma or other cancr have the high positive rate of CA19-9.The expression of p53, hMLH1、hMSH2and COX2 in colorectal cancer were high, but only the expression of hMLH1 in three groups is significant different. The expression of hMLH1 in right-sided colon cancer is lower than left-sided colon cancer and rectal.Conclusions:1. The component ratio of right-sided colon cancer has no obvious rise in recently 10 years, and the left-sided colon cancer has an annually rising in recently 4 years. So we should pay an attention to the left-sided colon cancer.2. Elderly patients are susceptibility to colon cancer, especially right-sided colon cancer. While the young and middle-aged patients with rectal cancer more. Male with colorectal cancer is more than female, but female is more susceptible to the right-sided colon cancer. The proportions of the mucous adenocarcinoma and poorly differentiated tumors in right-sided colon cancer are significantly higher than left-sided colon cancer and rectal cancer, which means the right-sided colon cancer has poor prognosis. The CEA positive rate and CA19-9 positive rate is higher, the worse prognosis of colorectal cancer.3. The hMLH1 expression rate is low in the right-sided colon cancer, which show right-sided colon cancer is more of MSI positive tumors.更多还原