外科理论与实践

外科理论与实践 ›› 2020, Vol. 25 ›› Issue (06): 498-502.doi: 10.16139/j.1007-9610.2020.06.011

• 论著 • 上一篇    下一篇

直肠癌环切缘阳性的危险因素分析

朱聪聪, 郑洪途, 徐烨()   

  1. 复旦大学附属肿瘤医院大肠外科 复旦大学上海医学院肿瘤学系,上海 200032
  • 收稿日期:2019-11-04 出版日期:2020-11-25 发布日期:2022-07-20
  • 通讯作者: 徐烨 E-mail:yexu@shmu.edu.cn
  • 基金资助:
    国家自然科学基金(81472620)

Analysis of risk factors for positive circumferential resection margin in rectal cancer

ZHU Congcong, ZHENG Hongtu, XU Ye()   

  1. Department of Colorectal Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
  • Received:2019-11-04 Online:2020-11-25 Published:2022-07-20
  • Contact: XU Ye E-mail:yexu@shmu.edu.cn

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摘要：

目的：探索直肠癌环切缘（circumferential resection margin, CRM）阳性的高危因素。方法：筛选2006年1月至2018年4月期间于复旦大学附属肿瘤医院手术治疗的直肠癌病人,纳入CRM阳性病人71例,按2∶1随机数法匹配142例CRM阴性病人作为阴性组。分析比较CRM阳性组与阴性组病人临床病理特征。通过单因素和多因素分析,得出CRM阳性的危险因素。结果：单因素分析发现,CRM阳性组与阴性组的肿瘤距肛门距离（P<0.001）、手术方式（P<0.001）、肿瘤分化程度（P<0.001）、脉管侵犯（P=0.001）、神经侵犯（P<0.001）、T分期（P<0.001）、N分期（P=0.001）、TNM分期（P<0.001）、新辅助放化疗（P=0.049）差异有统计学意义。CRM阳性组较阴性组局部复发率（P=0.001）及远处转移率（P<0.001）高,总生存率（P<0.001）低。多因素分析表明,低分化（OR=4.415,95% CI: 1.906~10.224,P=0.001）、神经侵犯（OR=3.344,95% CI: 1.431~7.817,P=0.005）和病理T分期T3~T4（OR=3.225,95% CI: 1.026~10.142,P=0.045）是CRM阳性的独立高危因素。结论：CRM阳性病人预后较差。肿瘤低分化、神经侵犯以及病理T分期T3~T4是直肠癌根治术后病理检查CRM阳性的高危因素。

关键词: 直肠癌, 环切缘, 高危因素

Abstract:

Objective To explore the higher risk factors for positive circumferential resection margin (CRM) in rectal cancer. Methods The patients with rectal cancer undergoing surgery in Fudan University Shanghai Cancer Center between January 2006 to April 2018 were collected, and 71 patients with positive CRM were included in positive group in this study. One hundred forty-two patients with negative CRM as negative group were matched by random number method with a ratio of 2∶1. Clinicopathologic analysis was done for positive group compared with negative group. Uni and multifactorial analysis assessed the risk factors for positive CRM. Results It was shown by univariate analysis of two groups that significantly different factors were distance of tumor to the anal verge (P<0.001), surgery type (P<0.001), differentiation extent (P<0.001), lymphovascular invasion P=0.001), perineural invasion (P<0.001), T stage (P<0.001), N stage (P=0.001), TNM stage (P<0.001), and neoadjuvant chemoradiotherapy (P=0.049). Patients in CRM positive group had higher locoregional recurrence rate(P=0.001), higher distant metastases rate (P<0.001) and less overall survival (P<0.001) compared with those in negative group. Multifactorial analysis demonstrated that poor differentiation (OR=4.415; 95% CI: 1.906-10.224; P=0.001), perineural invasion (OR=3.344; 95% CI: 1.431-7.817; P=0.005) and T3-T4 in pathological stage (OR=3.225; 95% CI: 1.026-10.142; P=0.045) were independent higher risk factors for positive CRM. Conclusions Positive CRM predicted a worse clinical outcome. Poor differentiation, perineural invasion and T3-T4 of pathological stage were higher risk factors for positive CRM in rectal cancer patients after curative surgery.

Key words: Rectal cancer, Circumferential resection margin, Higher risk factor

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