左右半結(jié)腸癌的臨床特征與生存預(yù)后差異的臨床觀察
發(fā)布時(shí)間：2018-07-23 18:16
【摘要】：目的:通過比較不同分期的左半結(jié)腸癌和右半結(jié)腸癌的臨床病理資料,分析不同分期的左右半結(jié)腸癌的臨床特點(diǎn)及生存預(yù)后情況,為臨床治療結(jié)腸癌及進(jìn)一步研究左右半結(jié)腸癌提供參考。方法:回顧性分析大連醫(yī)科大學(xué)附屬第一醫(yī)院2009年1月至2011年12月期間經(jīng)治的經(jīng)術(shù)后病理及腸鏡病理證實(shí)的178例結(jié)腸癌患者,采取調(diào)閱患者病歷資料收集患者年齡、性別、病理特征、治療情況等基礎(chǔ)資料,采用電話隨訪方式收集患者生存預(yù)后情況,依據(jù)患者結(jié)腸癌原發(fā)病灶位置分為左半結(jié)腸癌和右半結(jié)腸癌,按照美國癌癥聯(lián)合委員會(huì)結(jié)腸癌TNM系統(tǒng)(UⅠCC/AJCC)分期,以病灶原發(fā)位置和腫瘤分期分類分析患者一般臨床病理資料和生存預(yù)后的關(guān)系。結(jié)果:1.左右半結(jié)腸癌的臨床資料比較:左半結(jié)腸癌患者114例(占64.0%),其中Ⅰ-Ⅱ期43例、Ⅲ期51例、Ⅳ期20例,平均發(fā)病年齡為61.23±10.52;右半結(jié)腸癌患者64例(占36.0%),包括Ⅰ-Ⅱ期12例、Ⅲ期38例、Ⅳ期14例,平均發(fā)病年齡為60.39±12.02。總體上,右半結(jié)腸癌與左半結(jié)腸癌相比CEA陽性表達(dá)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);亞組分析Ⅰ-Ⅱ期右半結(jié)腸癌CEA≥5的比例高于左半結(jié)腸癌(66.7%vs32.6%,P=0.033)。2.左右半結(jié)腸癌的病理特征比較:總體上,右半結(jié)腸癌與左半結(jié)腸癌相比腫塊≥5cm的比例高(68.7%vs31.6%,P0.001)、淋巴結(jié)轉(zhuǎn)移的比例高(78.1%vs60.5%,P=0.017),病理類型是粘液腺癌/印戒細(xì)胞癌的比例高于左半結(jié)腸癌(23.4%vs9.6%,P=0.016),亞組分析Ⅰ-Ⅱ、Ⅲ期右半結(jié)腸癌腫塊大小≥5cm的比例高于左半結(jié)腸癌(分別是83.3%vs27.9%,P=0.001和68.4%vs35.3%,P=0.002);Ⅲ期結(jié)腸癌組中右半結(jié)腸癌的病理類型為粘液腺癌較左半結(jié)腸癌常見(28.9%vs9.8%,P=0.020)。3.總體生存預(yù)后的比較:對(duì)左右半結(jié)腸癌進(jìn)行生存預(yù)后分析顯示右半結(jié)腸癌患者較左半結(jié)腸癌患者生存預(yù)后差;Ⅰ-Ⅲ期結(jié)腸癌組中左半結(jié)腸癌的3年、5年DFS分別為78.3%,72.3%;右半結(jié)腸癌的3年、5年DFS分別為70.0%,60.0%(P=0.043);而Ⅰ-Ⅲ期左半結(jié)腸癌的3年、5年OS分別為88.3%、80.9%,右半結(jié)腸癌的3年、5年OS分別為82.0%、74.0%(P=0.019);Ⅳ左半結(jié)腸癌的m PFS為8.667個(gè)月(95%CⅠ 5.699-11.635),右半結(jié)腸癌的m PFS為7.100個(gè)月(95%CⅠ5.562-8.638),具有統(tǒng)計(jì)學(xué)差異(X2=3.829,P=0.050);Ⅳ期左半結(jié)腸癌的m OS為18.367個(gè)月(95%CⅠ 18.109-18.624),右半結(jié)腸癌的m OS為15.733個(gè)月(95%CⅠ11.746-19.720),差異有統(tǒng)計(jì)學(xué)意義(X2=4.488,P=0.034)。多因素分析顯示腫瘤原發(fā)灶位置(HR:2.783,95%CⅠ:1.158-6.691;P=0.022)是影響Ⅳ期結(jié)腸癌患者OS的預(yù)后因素。4.亞組分析顯示Ⅲ期結(jié)腸癌組中左半結(jié)腸癌的3年、5年DFS分別是72.5%、64.7%,右半結(jié)腸癌的3年、5年DFS分別是65.8%、55.3%,差異具有統(tǒng)計(jì)學(xué)意義(P=0.048);對(duì)Ⅲ期左右半結(jié)腸癌進(jìn)行3年、5年OS統(tǒng)計(jì)分析得出,左半結(jié)腸癌的3年、5年OS分別為84.3%、74.5%,而右半結(jié)腸癌的3年、5年OS為80.0%、68.4%,具有統(tǒng)計(jì)學(xué)差異(P=0.043)。Ⅰ-Ⅱ期結(jié)腸癌組中左半結(jié)腸癌的3年、5年DFS分別是86%、81.4%,右半結(jié)腸癌的3年、5年DFS分別是83.3%、75.0%;Ⅰ-Ⅱ期左半結(jié)腸癌的3年、5年OS分別是93.0%、88.4%,右半結(jié)腸癌的3年、5年OS分別為91.7%、91.7%,左右半結(jié)腸癌間均無差異無統(tǒng)計(jì)學(xué)意義(P=0.818,P=0.979)。結(jié)論:1.右半結(jié)腸癌中CEA≥5ng/ml的比例、AJCC分期為Ⅰ-Ⅱ期的比例高于左半結(jié)腸癌;右半結(jié)腸癌腫瘤體積大,病理類型為粘液腺癌及印戒細(xì)胞癌較左半結(jié)腸癌多見,淋巴道轉(zhuǎn)移比例高于左半結(jié)腸癌。2.生存預(yù)后可見,Ⅰ-Ⅲ期左半結(jié)腸癌的3年、5年DFS及3年、5年OS均高于右半結(jié)腸癌,Ⅳ期左半結(jié)腸癌的m PFS及m OS均優(yōu)于右半結(jié)腸癌。多因素分析得出:腫瘤原發(fā)灶位置可以作為Ⅳ期結(jié)腸癌患者OS的預(yù)后指標(biāo),而Ⅰ-Ⅲ期DFS及Ⅳ期PFS無相關(guān)影響因素。3.亞組分析顯示,Ⅰ-Ⅱ期中右半結(jié)腸癌CEA值≥5ng/ml的比例高于左半結(jié)腸癌,其余因素如性別、年齡等未見差異;Ⅰ-Ⅱ、Ⅲ期中,右半結(jié)腸癌較左半結(jié)腸癌腫塊大;Ⅲ期病理類型以粘液腺癌常見。4.亞組分析顯示,Ⅲ期左半結(jié)腸癌3年、5年DFS及3年、5年OS均高于右半結(jié)腸癌,而Ⅰ-Ⅱ期左右半結(jié)腸癌間未見差異;多因素分析未發(fā)現(xiàn)與Ⅰ-Ⅱ期及Ⅲ期結(jié)腸癌DFS相關(guān)的預(yù)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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.35
本文編號(hào)：2140224
[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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.35
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 萬顏凱;花秀英;;左右半結(jié)腸癌的臨床病理特征觀察[J];中國現(xiàn)代藥物應(yīng)用;2013年08期
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