發(fā)布時(shí)間：2018-06-27 22:11

  本文選題：結(jié)腸癌 + 位置��； 參考：《北京協(xié)和醫(yī)學(xué)院》2017年碩士論文

【摘要】：研究背景:結(jié)直腸癌是臨床常見惡性腫瘤,肝臟是結(jié)直腸癌最好發(fā)的轉(zhuǎn)移部位,在結(jié)直腸癌患者中,2/3死因與肝轉(zhuǎn)移相關(guān),因此,對(duì)于結(jié)直腸癌肝轉(zhuǎn)移的診治尤為重要。目前有關(guān)于結(jié)腸癌原發(fā)灶位置與CRCLM術(shù)后長期生存相關(guān)性的研究。本文旨在研究原發(fā)于左半及右半結(jié)腸的CRCLM患者在DFS以及OS上的差異,并分析預(yù)后相關(guān)因素。研究方法:回顧性分析北京協(xié)和醫(yī)學(xué)院中國醫(yī)學(xué)科學(xué)院腫瘤醫(yī)院2009-2016年行根治性治療(包括聯(lián)合射頻消融治療)的結(jié)腸癌肝轉(zhuǎn)移患者的診斷、治療及預(yù)后等臨床資料。將原發(fā)灶位于乙狀結(jié)腸、降結(jié)腸、脾曲的患者歸為左半結(jié)腸組,位于盲腸、升結(jié)腸、橫結(jié)腸的患者歸為右半結(jié)腸組,利用統(tǒng)計(jì)學(xué)軟件SPSS v20進(jìn)行統(tǒng)計(jì)學(xué)分析,比較兩組的生存差異,并分析其預(yù)后因素。研究結(jié)果:共有97例患者納入本研究,原發(fā)于左半結(jié)腸65例、右半結(jié)腸32例,兩組患者除接受新輔助化療比例外,余臨床病理特征無明顯差異。全部患者中位無疾病生存時(shí)間(DFS)9.0月,中位總生存時(shí)間(OS)41.0月,左、右半結(jié)腸組中位DFS分別為6.0月和9.0月,兩者無統(tǒng)計(jì)學(xué)顯著性差異(P=0.579)。左、右半結(jié)腸組中位OS(54.0月VS 33.0月)及5年生存率(34.8%VS 17.4%),亦無統(tǒng)計(jì)學(xué)顯著性差異(P=0.270)。單因素分析術(shù)前CA19-9、術(shù)前CEA、是否接受新輔助化療、肝轉(zhuǎn)移灶數(shù)量≥4與患者DFS有關(guān),僅肝轉(zhuǎn)移灶≥4是OS的危險(xiǎn)因素。結(jié)論:本研究結(jié)果表明肝轉(zhuǎn)移灶數(shù)量是結(jié)腸癌肝轉(zhuǎn)移術(shù)后影響總生存的獨(dú)立預(yù)后因素。與右半結(jié)腸癌肝轉(zhuǎn)移相比,左半結(jié)腸癌肝轉(zhuǎn)移患者行根治性治療術(shù)后DFS更短,OS延長,但均未達(dá)到統(tǒng)計(jì)學(xué)顯著性差異。
[Abstract]:Background: colorectal cancer is a common clinical malignant tumor, the liver is the best metastatic site of colorectal cancer. Two thirds of the causes of death are related to liver metastasis in patients with colorectal cancer. Therefore, the diagnosis and treatment of liver metastasis of colorectal cancer is particularly important. There is a study on the correlation between the location of primary colon cancer and long-term survival after CRCLM. The purpose of this study was to study the difference of DFS and OS in CRCLM patients with primary left and right hemicolon and to analyze the prognostic factors. Methods: the diagnosis, treatment and prognosis of patients with liver metastases from colon cancer treated with radical therapy (including radiofrequency ablation) from 2009 to 2016 in Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, were retrospectively analyzed. The patients with primary lesions located in sigmoid colon, descending colon and splenic flexure were classified as left hemicolon group, cecum, ascending colon and transverse colon group as right hemicolon group. Statistical software SPSS v20 was used for statistical analysis. The survival difference between the two groups was compared and the prognostic factors were analyzed. Results: a total of 97 patients were included in this study. There were 65 cases of left hemicolon and 32 cases of right hemicolon. Except for the proportion of neoadjuvant chemotherapy, there was no significant difference in clinicopathological features between the two groups. The median disease-free survival time (DFS) was 9.0 months, the median total survival time (OS) was 41.0 months, and the median DFS was 6.0 months and 9.0 months in the left and right hemicolon groups, respectively. There was no significant difference between the two groups (P0. 579). The median OS (54.0 months vs 33.0 months) and the 5-year survival rate (34.8vs 17.4%) in the left and right hemicolon groups were not significantly different (P = 0.270). Univariate analysis showed that preoperative CA19-9, preoperative CEA, neoadjuvant chemotherapy or not, the number of liver metastases 鈮，

本文編號(hào)：2075445