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目的探讨病理高危因素与I期直肠癌预后的关系,从而为临床提供有益的指导。方法回顾性分析2011年1月至2013年1月期间在哈尔滨医科大学附属第二医院结直肠肿瘤外科接受根治性手术治疗且术后病理回报为I期的直肠癌患者178例,分为有高危因素组和无高危因素组,有高危因素的患者119例,男性60例,女性59例;无高危因素的患者59例,男性33例,女性26例。中位随访时间为33个月,并详细记录患者的无病生存期。结果 2组患者在性别、年龄、大体类型、分化类型、淋巴结检出数目、浸润深度、肿瘤部位等方面比较差异无统计学意义(χ2=0.480,t=2.023,χ2=2.244,χ2=5.614,t=2.387,χ2=1.590,χ2=3.099,P均>0.05),2组术后随访时间相同,无高危因素组患者预后良好无复发及远处转移,而有高危因素组中出现了局部复发和远处转移的病例。有和无高危因素的I期直肠癌患者的无病生存期差异存在统计学意义(HR=0.86,95%CI 0.56~0.97)。淋巴管浸润、脉管瘤栓、神经侵犯及低分化是影响患者无病生存期的主要因素。结论对于含有病理高危因素的I期直肠癌患者应进行密切随访观察。
Objective To investigate the relationship between pathological risk factors and the prognosis of stage I rectal cancer so as to provide useful guidance for clinical practice. Methods A retrospective analysis of 178 patients with rectal cancer undergoing radical surgery in the Department of Colorectal Neoplasm at the Second Affiliated Hospital of Harbin Medical University from January 2011 to January 2013 and with postoperative pathological findings of I was retrospectively analyzed. In the factor group and non-risk group, there were 119 patients with high risk factors, 60 males and 59 females; 59 patients without risk factors, 33 males and 26 females. The median follow-up time was 33 months, and detailed records of patients with disease-free survival. Results There was no significant difference in gender, age, gross type, type of differentiation, number of lymph nodes, depth of invasion, tumor location and other aspects between the two groups (χ2 = 0.480, t = 2.023, χ2 = 2.244, χ2 = 5.614, t = 2.387, χ2 = 1.590, χ2 = 3.099, P> 0.05). The follow-up time was the same in both groups. There was no recurrence and distant metastasis in the patients without risk factors, And distant metastasis cases. There was a statistically significant difference in disease-free survival between patients with and without risk factors for stage I rectal cancer (HR = 0.86, 95% CI 0.56-0.97). Lymphatic invasion, tumor thrombus, nerve invasion and poor differentiation are the main factors affecting disease-free survival of patients. Conclusions Patients with stage I rectal cancer who have pathological risk factors should be closely followed up.