大肠癌根治术后复发的临床病理分析 - 第三军医大学学报.doc

230例复发大肠癌的临床病理分析 邹劲林1 汤聪1 孙晓卫 2 宋平亮3 〔1中山大学附属第五医院普外科，广东 珠海，519000〕 〔2中山大学附属肿瘤防治中心胃肠科，广东 广州，510060〕 （3珠海市人民医院普外科， 广东 珠海，519000〕 通讯作者：汤聪，男，博士，副主任医师，硕士生导师。电话0756-2528831， E-mail：congtusys@yeah.net 摘要 目的：探讨大肠癌临床病理特征对大肠癌术后复发的影响。方法：回顾性分析230例复发大肠癌病例的临床病理资料及其特点。结果：直肠癌30个月内复发率迅速上升，中位复发时间是18.6月；结肠癌20-40个月时复发率上升较快，中位复发时间是23.4月；结肠癌早期复发时间较直肠癌晚，复合复发时间晚于单部位复发时间（P0.05）。结肠癌首次复发后再次根治性切除率高于直肠癌（P0.05）。单因素分析显示：原发肿瘤位置、浸润的深度、淋巴结转移数目、肿瘤的显微镜下类型、术中化疗与否、血管是否有癌栓和早期复发有关（P0.05），但多因素分析显示只有肿瘤浸润深度是独立影响因素。复发病例再次根治性手术者5年生存率明显高于无法根治性手术者。结论：大肠癌早期复发高峰在术后40个月内，肿瘤浸润深度是独立影响因素，而原发肿瘤位置、淋巴结转移数目、肿瘤的显微镜下类型、术中化疗与否、血管是否有癌栓是影响早期复发的重要因素。复发病例再次根治性手术可以改善其预后。 [关键词] 大肠癌 复发 影响因素 The Clinical and pathological analysis of recurrence of colorectal cancer Zou Jin-lin Tang Cong Sun Hua-bin Song Ping-liang 1 The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai , Guangdong, 519000 2 Sun Yat-Sen University cancer center，Guangzhou，Guangdong, 510060 3 Zhuhai peoples hospital, Zhuhai , Guangdong, 519000 [Abstract] Objective: to study the effect of clinicopathological features of colorectal cancer to tumor recurrence postoperation. Methods: a retrospective analysis of clinical pathological data and its characteristics in 230 recurred colorectal cancer cases. Results: For rectal cancer, recurrence rates was rising rapidly in 30 months; median time to recurrence was 18.6 months; as for colon cancer, recurrence rates rose faster during 20-40; median time to recurrence was 23.4 months. early recurrence occurred later in colon cancer versus rectal cancer; recurrence time of multiple sites recurrence was later than that of single sites recurrence (P 0.05). Radical resection rates after first relapse was higher in colon cancer versus rectal cancer (P 0.05). Single factor analysis showed that the location of primary tumor, infiltrating depth, number of metastic lymph node, microscopic types of tumor, intraoperative chemotherapy or not and tumor emboli in vessles were relevant with early recurrence