摘要
目的 比较左半结肠癌（LC）和右半结肠癌（RC）的临床病理特征和长期预后的差异。方法 2000年1月至2010年12月，上海第二军医大学附属长海医院行手术治疗结肠腺癌患者2 174例，排除横结肠癌、部位重叠、部位不明、复发癌、多原发癌、伴发其他恶性肿瘤、术前化疗、局部切除、临床数据不完善和失访者，最终纳入1 036例行原发灶根治性切除患者的临床病理资料进行回顾性研究。将其中563例盲肠癌、升结肠癌和结肠肝曲癌患者纳入RC组，473例结肠脾曲癌、降结肠癌和乙状结肠癌患者纳入LC组。比较两组患者的临床病理特征和预后，预后包括中位总生存期、5年总生存率以及肿瘤特异性中位总生存期（是指从手术日期开始至由于肿瘤进展导致患者死亡的时间）和肿瘤特异性5年总生存率（是指从手术日期开始到术后5年内，未死于肿瘤进展的患者占病例总数的比率），多因素Cox回归分析预后的影响因素。继之采用＂倾向评分匹配＂的方法平衡两组的临床病理因素，SAS 9.3软件进行倾向评分匹配，将年龄、性别、大体类型、肿瘤直径、浸润深度、淋巴结转移、远处转移、TNM分期、分化程度、癌胚抗原（CEA）和糖类抗原（CA）19-9纳入倾向评分，然后按照评分的分值对两组进行匹配，再比较两组患者的临床病理特征和预后的差异。结果 两组患者的年龄、肿瘤远处转移率和CEA水平的差异无统计学意义（P 〉 0.05）。与RC组相比，LC组男性[60.9%（343/563）比51.0%（241/473），P= 0.001]、溃疡型肿瘤[71.9%（405/563）比65.3%（309/473），P= 0.006]、高和中分化肿瘤[87.5%（493/563）比73.8%（349/473），P= 0.000]、T1~2期肿瘤[17.1%（96/563）比10.1%（48/473），P= 0.001]、TNM分期Ⅰ期肿瘤[13.3%（75/563）比7.8%（37/473），P= 0.000]、肿瘤直径〈 5.0 cm[55.1%（310/563）比38.3%（181/473），P= 0.000]以及CA19-9 〈 37 kU/L[68.4%（385/563）比62.6%（296/473），P= 0.022]的患者比例较高；而N0期肿瘤[53.3%（300/563）比62.4%（295/473），P= 0.013]患者比例较低。LC组与RC组中位总生存期分别为82月和76月，两组5年总生存率分别为58.3%和50.9%，差异有统计学意义（P= 0.038）；中位肿瘤特异性生存期分别为84月和78月，5年肿瘤特异性生存率分别为60.6%和52.9%，差异亦有统计学意义（P= 0.031）。多因素Cox回归分析显示，肿瘤位置并不是影响LC组和RC组患者总生存时间和肿瘤特异性生存时间的预后因素（分别P= 0.106和P=0.091）。采用倾向评分匹配后，共成功匹配354对。两组倾向指数差异无统计学意义（0.458 ± 0.129比0.459 ± 0.129，P= 0.622）。LC与RC患者匹配后的5年总生存率分别为54.0%和51.7%（P= 0.982），5年肿瘤特异性生存率分别为56.4%和53.1%（P= 0.819），差异均无统计学意义。结论 LC和RC患者临床病理各有特征，但预后相同。
Objective To compare the clinicopathological features and prognosis between left-sided colon cancer （LC） and right-sided colon cancer （RC） .Methods Clinicopathological and follow-up data of 2 174 colon carcinoma cases undergoing resection at Shanghai Changhai Hospital of The Second Military Medical University from January 2000 to December 2010 were retrospectively analyzed. Patients with transverse colon cancer, overlapping position, unknown location, recurrent cancer, multiple primary cancer, concomitant malignant tumors, preoperative chemotherapy, local resection, incomplete clinical data and missed follow up were excluded. Finally, a total of 1 036 patients, whose primary tumors were radically removed, were enrolled, with 563 patients in LC group （including carcinoma in cecum, ascending colon and hepatic flexure） and 473 in RC group （including carcinoma in splenic flexure, descending colon and sigmoid colon） . The clinicopathological features and survival, including median overall survival, 5-year overall survival rate, tumor specific median overall survival, cancer specific 5-year overall survival rate, were compared between LC and RC groups. Tumor specific overall survival was defined as the period between operation date to the date of death caused by cancer progression. Multivariate Cox regression analysis was used to analyze the influencing factors of survival. Propensity score matching was carried out to balance the clinicopathological factors between the two groups with the SAS 9.3, taking the following parameters into consideration （age, gender, gross appearance, tumor diameter, invasion depth, lymph node metastasis, distant metastasis, TNM stages, differentiation, CEA and CA199-9） . Patients in RC group and LC group were matched according to the propensity scores and the clinicopathological characteristics and prognosis of two groups were compared again.Results No significant differences were identified between the two groups in age, distant metastasis and serum CEA level. Compared with RC group, LC group had more male patients[60.9% （343/563） vs. 51.0% （241/473） , P= 0.001], more ulcerative tumors[71.9% （405/563） vs. 65.3% （309/473） , P= 0.006], better differentiation[well/moderately differentiated： 87.5% （493/563） vs. 73.8% （349/473） , P= 0.000], lower infiltration depth[T1-2： 17.1% （96/563） vs. 10.1% （48/473） , P= 0.001], higher lymph node metastasis rate[N0： 53.3% （300/563） vs. 62.4% （295/473） , P= 0.013], lower TNM stage[stageⅠ： 13.3% （75/563） vs. 7.8% （37/473） , P= 0.000], lower serum CA199 level[〈 37 kU/L： 68.4% （385/563） vs. 62.6% （296/473） , P= 0.022]and smaller tumor diameter[〈 5.0 cm： 55.1% （310/563） vs. 38.3% （181/473） , P= 0.000]. The median overall survival was 82 months and 76 months in LC and RC groups, respectively, and the 5-year overall survival rate was 58.3% and 50.9% （P= 0.038） . The median tumor specific survival was 84 months and 78 months in LC and RC groups, respectively, and the 5-year tumor specific overall survival rate was 60.6% and 52.9% （P= 0.031） . Multivariate Cox regression analysis showed that tumor location （LC vs. RC） was not associated with overall survival （P= 0.106） and tumor specific survival （P= 0.091） . After propensity score matching, no significant difference was found in clinicopathological factors and propensity score （0.458 ± 0.129 vs. 0.459 ± 0.129, P= 0.622） between LC and RC group. After matching, there was no significant difference in overall survival rate （54.0% vs. 51.7%, P= 0.982） and tumor specific overall survival rate （56.4% vs. 53.1%, P= 0.819） between two groups.Conclusion Significant difference exists between RC and LC in clinicopathological factors, but not in survival.
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2017年第6期647-653,共7页
Chinese Journal of Gastrointestinal Surgery
基金
国家自然科学基金（81201936、81572332、81572358）
关键词
结肠肿瘤
肿瘤位置
总生存时间
预后
倾向评分匹配
Colon neoplasms
Tumor location
Overall survival
Prognosis
Propensity score matching
作者简介
通信作者：张卫，Email：weizhang2000cn@163．com
