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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。
BACKGROUND & AIM: Total mesorectal excision (TME) can significantly reduce the local recurrence rate of rectal cancer and improve the prognosis of patients. This study retrospectively analyzed the clinicopathological features of 1056 cases of rectal cancer treated with radical TME and its relationship with prognosis. Methods: A total of 1056 cases of rectal cancer undergoing radical TME between 1990 and 2003 were collected to establish a database. Univariate analysis and multivariate analysis were used to investigate the effect of 20 clinical and pathological parameters on the prognosis of patients with rectal cancer undergoing radical TME. Results: The overall 3-year, 5-year and 10-year survival rates were 84.9% (95.8% CI 83.8% -86.0%), 73.8% (95% CI 72.4% -75.2%) and 65.1% % CI, 63.4% ~ 66.8%). Univariate analysis showed that preoperative serum CEA levels and CA19-9 levels, preoperative bowel obstruction or perforation, gross tumor type, tumor type, pathological grade, depth of invasion of the intestinal wall, lymph node metastasis and initial treatment time were rectal cancer Factors influencing prognosis of TME patients. Cox proportional hazard regression model multivariate analysis showed that lymph node metastasis, tissue type, surgical approach and depth of invasion were independent prognostic factors. Conclusion: The lymph node metastasis, the type of tissue, the operation method and the depth of invasion of the intestinal wall can be used as a reference index to judge the prognosis of patients with rectal cancer.