左右半结肠癌的临床特征与生存预后差异的临床观察

发布时间：2018-07-23 18:16

【摘要】：目的:通过比较不同分期的左半结肠癌和右半结肠癌的临床病理资料,分析不同分期的左右半结肠癌的临床特点及生存预后情况,为临床治疗结肠癌及进一步研究左右半结肠癌提供参考。方法:回顾性分析大连医科大学附属第一医院2009年1月至2011年12月期间经治的经术后病理及肠镜病理证实的178例结肠癌患者,采取调阅患者病历资料收集患者年龄、性别、病理特征、治疗情况等基础资料,采用电话随访方式收集患者生存预后情况,依据患者结肠癌原发病灶位置分为左半结肠癌和右半结肠癌,按照美国癌症联合委员会结肠癌TNM系统(UⅠCC/AJCC)分期,以病灶原发位置和肿瘤分期分类分析患者一般临床病理资料和生存预后的关系。结果:1.左右半结肠癌的临床资料比较:左半结肠癌患者114例(占64.0%),其中Ⅰ-Ⅱ期43例、Ⅲ期51例、Ⅳ期20例,平均发病年龄为61.23±10.52;右半结肠癌患者64例(占36.0%),包括Ⅰ-Ⅱ期12例、Ⅲ期38例、Ⅳ期14例,平均发病年龄为60.39±12.02。总体上,右半结肠癌与左半结肠癌相比CEA阳性表达率高(58.5%vs 39.6%,P=0.028),UⅠCC/AJCC分期Ⅰ-Ⅱ期比例低(18.8%vs 37.7%,P=0.031);亚组分析Ⅰ-Ⅱ期右半结肠癌CEA≥5的比例高于左半结肠癌(66.7%vs32.6%,P=0.033)。2.左右半结肠癌的病理特征比较:总体上,右半结肠癌与左半结肠癌相比肿块≥5cm的比例高(68.7%vs31.6%,P0.001)、淋巴结转移的比例高(78.1%vs60.5%,P=0.017),病理类型是粘液腺癌/印戒细胞癌的比例高于左半结肠癌(23.4%vs9.6%,P=0.016),亚组分析Ⅰ-Ⅱ、Ⅲ期右半结肠癌肿块大小≥5cm的比例高于左半结肠癌(分别是83.3%vs27.9%,P=0.001和68.4%vs35.3%,P=0.002);Ⅲ期结肠癌组中右半结肠癌的病理类型为粘液腺癌较左半结肠癌常见(28.9%vs9.8%,P=0.020)。3.总体生存预后的比较:对左右半结肠癌进行生存预后分析显示右半结肠癌患者较左半结肠癌患者生存预后差;Ⅰ-Ⅲ期结肠癌组中左半结肠癌的3年、5年DFS分别为78.3%,72.3%;右半结肠癌的3年、5年DFS分别为70.0%,60.0%(P=0.043);而Ⅰ-Ⅲ期左半结肠癌的3年、5年OS分别为88.3%、80.9%,右半结肠癌的3年、5年OS分别为82.0%、74.0%(P=0.019);Ⅳ左半结肠癌的m PFS为8.667个月(95%CⅠ 5.699-11.635),右半结肠癌的m PFS为7.100个月(95%CⅠ5.562-8.638),具有统计学差异(X2=3.829,P=0.050);Ⅳ期左半结肠癌的m OS为18.367个月(95%CⅠ 18.109-18.624),右半结肠癌的m OS为15.733个月(95%CⅠ11.746-19.720),差异有统计学意义(X2=4.488,P=0.034)。多因素分析显示肿瘤原发灶位置(HR:2.783,95%CⅠ:1.158-6.691;P=0.022)是影响Ⅳ期结肠癌患者OS的预后因素。4.亚组分析显示Ⅲ期结肠癌组中左半结肠癌的3年、5年DFS分别是72.5%、64.7%,右半结肠癌的3年、5年DFS分别是65.8%、55.3%,差异具有统计学意义(P=0.048);对Ⅲ期左右半结肠癌进行3年、5年OS统计分析得出,左半结肠癌的3年、5年OS分别为84.3%、74.5%,而右半结肠癌的3年、5年OS为80.0%、68.4%,具有统计学差异(P=0.043)。Ⅰ-Ⅱ期结肠癌组中左半结肠癌的3年、5年DFS分别是86%、81.4%,右半结肠癌的3年、5年DFS分别是83.3%、75.0%;Ⅰ-Ⅱ期左半结肠癌的3年、5年OS分别是93.0%、88.4%,右半结肠癌的3年、5年OS分别为91.7%、91.7%,左右半结肠癌间均无差异无统计学意义(P=0.818,P=0.979)。结论:1.右半结肠癌中CEA≥5ng/ml的比例、AJCC分期为Ⅰ-Ⅱ期的比例高于左半结肠癌;右半结肠癌肿瘤体积大,病理类型为粘液腺癌及印戒细胞癌较左半结肠癌多见,淋巴道转移比例高于左半结肠癌。2.生存预后可见,Ⅰ-Ⅲ期左半结肠癌的3年、5年DFS及3年、5年OS均高于右半结肠癌,Ⅳ期左半结肠癌的m PFS及m OS均优于右半结肠癌。多因素分析得出:肿瘤原发灶位置可以作为Ⅳ期结肠癌患者OS的预后指标,而Ⅰ-Ⅲ期DFS及Ⅳ期PFS无相关影响因素。3.亚组分析显示,Ⅰ-Ⅱ期中右半结肠癌CEA值≥5ng/ml的比例高于左半结肠癌,其余因素如性别、年龄等未见差异;Ⅰ-Ⅱ、Ⅲ期中,右半结肠癌较左半结肠癌肿块大;Ⅲ期病理类型以粘液腺癌常见。4.亚组分析显示,Ⅲ期左半结肠癌3年、5年DFS及3年、5年OS均高于右半结肠癌,而Ⅰ-Ⅱ期左右半结肠癌间未见差异;多因素分析未发现与Ⅰ-Ⅱ期及Ⅲ期结肠癌DFS相关的预后因素。
[Abstract]:Objective: To compare the clinical and pathological data of left and right colon cancer in different stages, analyze the clinical characteristics and survival prognosis of left and right colon cancer in different stages, and provide reference for clinical treatment of colon cancer and further study of left and right colon cancer. Methods: retrospective analysis of the First Affiliated Hospital of Dalian Medical University, 200 From January to December 2011, 9 patients with colon cancer confirmed by postoperative pathology and enteroscopy were collected and collected to collect patients' age, sex, pathological features, treatment and other basic data. The patients' survival prognosis was collected by telephone follow up, and the patients were divided into the left colon cancer primary focus position to the left. Semi colon and right colon cancer, according to the TNM system (U I CC/AJCC) staging of the cancer Joint Commission of the United States, the relationship between the general clinicopathological data and survival prognosis of the patients was analyzed by the primary location of the lesion and the tumor staging. Results: the clinical data of 1. and a half colon cancer were compared: 114 cases (64%) were left half colon cancer patients (64%). There were 43 cases in stage I - II, 51 cases in stage III, 20 cases in stage IV, the average age of onset was 61.23 + 10.52, and 64 cases in right colon cancer patients (36%), including 12 cases in stage I - II, 38 of stage III, 14 cases in stage IV, average age of 60.39 + 12.02., the positive rate of right half colon cancer compared with left hemicolon (58.5%vs 39.6%, P=0.028) and U I CC/AJCC points. The proportion of stage I - II stage was low (18.8%vs 37.7%, P=0.031). The proportion of CEA > 5 in stage I - II right half colon cancer was higher than that of left half colon cancer (66.7%vs32.6%, P=0.033).2. left and right colon cancer: Overall, the proportion of right half colon and left semicolon colon was higher than 5cm (68.7%vs31.6%, P0.001) and lymph node metastasis The proportion is high (78.1%vs60.5%, P=0.017). The pathological type is that the proportion of mucous adenocarcinoma / signet ring cell carcinoma is higher than that of left semicolon (23.4%vs9.6%, P=0.016). The subgroup analysis I - II, the proportion of the size of the lump in the third stage right half colon cancer is higher than that of the left colon cancer (83.3% vs27.9%, P=0.001 and 68.4%vs35.3%, P=0.002), and the right half of the third stage colon cancer group. The pathological type of colon cancer was the comparison of the overall survival prognosis of the common (28.9%vs9.8%, P=0.020).3. in the mucous adenocarcinoma. The survival prognosis of the left and right colon cancer patients showed that the survival of the right semi colon cancer patients was worse than that of the left semi colon cancer patients; the 3 year of the left half colon cancer in the stage I - III colon cancer group was 78.3%, and the 5 year DFS was 78.3%, 72 respectively. .3%, 3 years for right colon cancer, and 5 year DFS were 70%, 60% (P=0.043), and 3 years of left colon cancer in stage I - III, 5 year OS for 88.3%, 80.9%, right half colon cancer, 5 years OS, 82%, 74% (P=0.019), m PFS for left colon cancer for 8.667 months (95%C I 5.699-11.635), m PFS for right semi colon cancer for 7.100 months -8.638), with statistical difference (X2=3.829, P=0.050); the m OS of left colon cancer in stage IV was 18.367 months (95%C I 18.109-18.624), m OS in right colon cancer was 15.733 months (95%C I 11.746-19.720). The difference was statistically significant (X2=4.488,). The prognostic factor of OS in stage IV colon cancer patients.4. subgroup analysis showed 3 years of left colon cancer in stage III colon cancer group, 5 years DFS were 72.5%, 64.7%, 3 year of right half colon cancer, 5 year DFS respectively 65.8%, 55.3%, respectively (P=0.048), 3 years for stage III colon cancer and 5 years OS statistical analysis, left half 3 years of colon cancer, 5 years OS were 84.3%, 74.5%, and 3 years for right half colon cancer, 5 year OS 80%, 68.4%, with statistical difference (P=0.043). In stage I - II colon cancer group, left semicolon colon cancer in 3 years, 5 years, 81.4%, right half colon cancer, DFS %, 88.4%, and right half colon cancer for 3 years, 5 years OS were 91.7%, 91.7%, and there was no difference between left and right colon cancer (P=0.818, P=0.979). Conclusion: the proportion of CEA more than 5ng/ml in 1. right colon cancer, the proportion of AJCC stage is higher than left half colon cancer; right half colon cancer volume is large, pathological type is mucous adenocarcinoma and signet ring Cell carcinoma is more common than left semicolon, and the proportion of lymphatic metastasis is higher than that of.2. in left colon cancer. 3 years, 5 years, 5 years and 3 years, 5 years OS are higher than right half colon cancer, and m PFS and m OS in stage IV left colon cancer are superior to that of right colon cancer. The prognostic indicators of OS in patients with colon cancer, while phase I - III DFS and stage IV PFS without correlation factors,.3. subgroup analysis showed that the proportion of CEA value of right half colon cancer in stage I - II was higher than that of left colon cancer, and the other factors such as sex and age were not different. In stage I - II, stage III, right semi colon cancer was larger than that of left semicolon carcinoma; stage III pathological class The common.4. subgroup analysis in mucous adenocarcinoma showed that stage III left colon cancer for 3 years, 5 years of DFS and 3 years, 5 years' OS were higher than right half colon cancer, but no difference was found between the left and right half colon cancer. The multivariate analysis did not find the prognostic factors associated with DFS in stage I and stage III colon cancer.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.35

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