早期结直肠癌内镜非治愈性切除患者预后相关危险因素研究

发布时间：2018-04-19 08:05

  本文选题：早期结直肠癌 + 非治愈性切除　； 参考：《北京协和医学院》2017年硕士论文

【摘要】：目的:早期结直肠癌是指局限于黏膜层或者黏膜下层的癌,无论其大小及是否有淋巴结转移。对于黏膜下浸润癌,根据其浸润深度可分为:SM1(癌组织浸润黏膜下层上1/3)、SM2(癌组织浸润黏膜下层中1/3)和SM3(癌组织浸润黏膜下层下1/3)。早期结直肠癌内镜切除技术主要包括:内镜下黏膜切除术(EMR)和内镜黏膜下剥离术(ESD)。根据中国早期结直肠癌筛查及内镜诊治指南,治愈性切除是指切除标本水平和垂直切缘均为阴性且无淋巴结转移风险;切除标本水平和/或垂直切缘阳性或存在淋巴结转移风险的则为非治愈性切除。本研究旨在分析早期结直肠癌内镜非治愈性切除患者的临床及病理资料,探索影响非治愈性切除患者无病生存的危险因素。方法:收集2009年1月至2015年1月行内镜切除治疗的早期结直肠癌及上皮内瘤变患者的临床资料和病理资料,分析这些因素对早期结直肠癌内镜非治愈性切除术后患者无病生存的影响。无病生存的评价采用Kaplan-Meier法,差别比较采用Log-Rank检验;多因素采用Cox回归分析来评估患者转移/复发的风险比(HR)。结果:共收集840例早期结直肠癌及上皮内瘤变的内镜切除病例,根据中国早期结直肠癌筛查及内镜诊治指南意见,有56(56/840,6.7%)例非治愈性切除病例纳入本研究。3年转移/复发率为14.3%(8/56),3年无病生存率为85.7%(48/56),3年总生存率为94.6%(53/56)。单因素分析发现:低分化腺癌(P=0.010,χ2=6.711)、黏膜下浸润深度≥2000 μm(P=0.009,x2=6.745)、脉管侵犯(P=0.005,χ2=7.708)对非治愈性切除患者3年的无病生存的影响有显著差异。多因素Cox回归分析发现:低分化腺癌(P=0.015,HR=8.021,95%CI:1.499-42.921)、黏膜下浸润深度≥2000 μm(P=0.023,HR=6.823,95%CI:1.299-35.848)、脉管侵犯(P=0.009,HR=18.143,95%CI:2.079-158.358)是早期结直肠癌内镜非治愈性切除患者术后无病生存的独立危险因素。结论:现有的早期结直肠癌内镜治愈性切除的判定标准有待于进一步完善和补充,同时现有判定标准的精准度也有待于进一步提高。本研究结果表明,早期结直肠癌内镜治疗后病理提示低分化腺癌、黏膜下浸润深度≥2000 μm、有脉管侵犯特征的是非治愈性切除术后预后不良的独立危险因素。
[Abstract]:Objective: early colorectal cancer is a cancer that is confined to the mucosal layer or submucosa, regardless of its size and lymph node metastasis.For submucosal invasive carcinoma, according to the depth of invasion, it can be divided into two groups: 1 / SM1 (1 / 3 of the submucosal invasion of cancer tissue) and SM3 (1 / 3 / 3 of the submucous infiltrating submucous layer of cancer tissue).Endoscopic resection of early colorectal cancer mainly includes endoscopic mucosal resection (EMRs) and endoscopic submucosal dissection (ESD).According to the guidelines for screening and endoscopic diagnosis and treatment of early colorectal cancer in China, curative resection means that the horizontal and vertical margin of the excision specimen is negative and has no risk of lymph node metastasis.Non-curable excision was found in the horizontal and / or vertical margin of the excision specimens or the risk of lymph node metastasis.The purpose of this study was to analyze the clinical and pathological data of patients with early endoscopic noncurable resection of colorectal cancer and to explore the risk factors affecting the disease-free survival of patients with non-curable resection.Methods: the clinical and pathological data of patients with early colorectal cancer and intraepithelial neoplasia treated by endoscopic resection from January 2009 to January 2015 were collected.To analyze the effect of these factors on the disease-free survival of early colorectal cancer patients after endoscopic non-curable resection.Kaplan-Meier method was used to evaluate disease-free survival, and Log-Rank test was used to compare the differences. Multivariate Cox regression analysis was used to evaluate the risk of metastasis / recurrence.Results: a total of 840 cases of early colorectal cancer and intraepithelial neoplasia were resected by endoscope. According to the guidelines for screening and endoscopic diagnosis and treatment of early colorectal cancer in China.The 3-year metastasis / recurrence rate was 14.3% / 56%, the 3-year disease-free survival rate was 85.7% / 56%, and the 3-year overall survival rate was 94.6% / 56%.Univariate analysis showed that there were significant differences in the effects of P0. 010, 蠂 2 + 6. 711, submucosal invasion depth 鈮，

本文编号：1772260