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目的 探讨直肠癌患者临床病理特征及术后生存的影响因素。方法 以 95 2例经手术治疗和病理确诊且随访资料完整的直肠癌患者为样本 ,采用单因素和多因素Cox回归分析方法分析直肠癌患者预后的影响因素。结果 直肠癌手术以Miles手术居多 ,占 5 3.5 % ,手术死亡率为 0 .3%。中分化腺癌患者 4 79例 ,占 5 0 .3%。肿瘤直径 4～ 8cm者 5 36例 ,占 5 6 .3%。 4 18例患者于术后 10 8个月内死于复发和转移。随访期间 ,5 3例发生肝转移 ,39例发生肺转移 ,12例发生骨转移。患者的平均生存时间为 (73.5 2± 1.70 )个月。总的 3,5 ,10年生存率分别为 6 7.6 %、5 5 .4 %和 38.2 %。单因素分析表明 ,患者的性别、年龄、肿瘤的根治度、病理类型、肿瘤直径、肝转移、肺转移及肿瘤的病理分期均为预后影响因素。Cox回归分析显示 ,肿瘤根治度、病理类型、肿瘤侵犯深度、淋巴结转移、肿瘤的病理分期、肝转移及肺转移是影响患者术后生存的独立因素。结论 影响直肠癌患者术后生存的独立因素有肿瘤的根治度、淋巴结转移、病理分期、侵犯深度、病理类型和肝肺转移。
Objective To investigate the clinicopathological features and the influencing factors of postoperative survival in patients with rectal cancer. Methods A total of 952 patients with pathologically confirmed and pathologically confirmed rectal cancer were enrolled in this study. Univariate and multivariate Cox regression analysis was used to analyze the prognostic factors in patients with rectal cancer. Results The majority of rectal cancer surgeries were operated on Miles, accounting for 53.5% and the operative mortality rate was 0.3%. There were 4 79 cases of differentiated adenocarcinoma, accounting for 50.3%. Tumor diameter 4 ~ 8cm 536 cases, accounting for 56.3%. Four 18 patients died of recurrence and metastasis within 108 months. During the follow-up, 53 cases had liver metastases, 39 cases had lung metastases, and 12 cases had bone metastases. The average survival time of patients was (73.5 2 ± 1.70) months. The overall 3,5-year and 10-year survival rates were 6 7.6%, 55.4% and 38.2%, respectively. Univariate analysis showed that the patients’ gender, age, tumor’s radical degree, pathological type, tumor diameter, liver metastasis, lung metastasis and pathological staging of the tumor were prognostic factors. Cox regression analysis showed that the tumor radicality, pathological type, depth of tumor invasion, lymph node metastasis, pathological stage of the tumor, liver metastasis and lung metastasis were the independent factors affecting the postoperative survival. Conclusion The independent factors influencing the postoperative survival of patients with rectal cancer are tumor radicality, lymph node metastasis, pathological stage, invasion depth, pathological type and liver-lung metastasis.