本文選題：早期結(jié)直腸癌 + 非治愈性切除　； 參考：《北京協(xié)和醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:早期結(jié)直腸癌是指局限于黏膜層或者黏膜下層的癌,無(wú)論其大小及是否有淋巴結(jié)轉(zhuǎn)移。對(duì)于黏膜下浸潤(rùn)癌,根據(jù)其浸潤(rùn)深度可分為:SM1(癌組織浸潤(rùn)黏膜下層上1/3)、SM2(癌組織浸潤(rùn)黏膜下層中1/3)和SM3(癌組織浸潤(rùn)黏膜下層下1/3)。早期結(jié)直腸癌內(nèi)鏡切除技術(shù)主要包括:內(nèi)鏡下黏膜切除術(shù)(EMR)和內(nèi)鏡黏膜下剝離術(shù)(ESD)。根據(jù)中國(guó)早期結(jié)直腸癌篩查及內(nèi)鏡診治指南,治愈性切除是指切除標(biāo)本水平和垂直切緣均為陰性且無(wú)淋巴結(jié)轉(zhuǎn)移風(fēng)險(xiǎn);切除標(biāo)本水平和/或垂直切緣陽(yáng)性或存在淋巴結(jié)轉(zhuǎn)移風(fēng)險(xiǎn)的則為非治愈性切除。本研究旨在分析早期結(jié)直腸癌內(nèi)鏡非治愈性切除患者的臨床及病理資料,探索影響非治愈性切除患者無(wú)病生存的危險(xiǎn)因素。方法:收集2009年1月至2015年1月行內(nèi)鏡切除治療的早期結(jié)直腸癌及上皮內(nèi)瘤變患者的臨床資料和病理資料,分析這些因素對(duì)早期結(jié)直腸癌內(nèi)鏡非治愈性切除術(shù)后患者無(wú)病生存的影響。無(wú)病生存的評(píng)價(jià)采用Kaplan-Meier法,差別比較采用Log-Rank檢驗(yàn);多因素采用Cox回歸分析來(lái)評(píng)估患者轉(zhuǎn)移/復(fù)發(fā)的風(fēng)險(xiǎn)比(HR)。結(jié)果:共收集840例早期結(jié)直腸癌及上皮內(nèi)瘤變的內(nèi)鏡切除病例,根據(jù)中國(guó)早期結(jié)直腸癌篩查及內(nèi)鏡診治指南意見(jiàn),有56(56/840,6.7%)例非治愈性切除病例納入本研究。3年轉(zhuǎn)移/復(fù)發(fā)率為14.3%(8/56),3年無(wú)病生存率為85.7%(48/56),3年總生存率為94.6%(53/56)。單因素分析發(fā)現(xiàn):低分化腺癌(P=0.010,χ2=6.711)、黏膜下浸潤(rùn)深度≥2000 μm(P=0.009,x2=6.745)、脈管侵犯(P=0.005,χ2=7.708)對(duì)非治愈性切除患者3年的無(wú)病生存的影響有顯著差異。多因素Cox回歸分析發(fā)現(xiàn):低分化腺癌(P=0.015,HR=8.021,95%CI:1.499-42.921)、黏膜下浸潤(rùn)深度≥2000 μm(P=0.023,HR=6.823,95%CI:1.299-35.848)、脈管侵犯(P=0.009,HR=18.143,95%CI:2.079-158.358)是早期結(jié)直腸癌內(nèi)鏡非治愈性切除患者術(shù)后無(wú)病生存的獨(dú)立危險(xiǎn)因素。結(jié)論:現(xiàn)有的早期結(jié)直腸癌內(nèi)鏡治愈性切除的判定標(biāo)準(zhǔn)有待于進(jìn)一步完善和補(bǔ)充,同時(shí)現(xiàn)有判定標(biāo)準(zhǔn)的精準(zhǔn)度也有待于進(jìn)一步提高。本研究結(jié)果表明,早期結(jié)直腸癌內(nèi)鏡治療后病理提示低分化腺癌、黏膜下浸潤(rùn)深度≥2000 μm、有脈管侵犯特征的是非治愈性切除術(shù)后預(yù)后不良的獨(dú)立危險(xiǎn)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，

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