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背景与目的:中下段直肠癌在我国发生率较高,如何提高中下段直肠癌治疗效果的研究一直受到关注。本研究旨在探讨中下段直肠癌患者根治术后临床及病理特征与预后的关系。方法:回顾性分析中山大学肿瘤防治中心1990年～1999年收治的599例中下段直肠癌患者的临床及病理资料。全组患者中行经腹会阴联合切除术(abdominoperinealresection,APR)355例,低位前切除术(lowanteriorresection,LAR)244例。采用寿命表法计算生存率,log-rank检验进行生存曲线比较,应用Cox比例风险模型进行多因素分析。结果:全组总的5年生存率为70.7%,其中APR与LAR依次为:67.5%、75.2%(P=0.026)。单因素分析显示,局部复发、围手术期输血、T分期、淋巴结转移、手术方式、肿瘤大体类型、组织类型以及肿瘤距肛缘长度与中下段直肠癌患者预后相关(P<0.05)。多因素分析显示,局部复发、围手术期输血、T分期和淋巴结转移是影响预后的独立因素(P<0.01)。结论:局部复发、围手术期输血、T分期和淋巴结转移是影响中下段直肠癌患者预后重要的指标。LAR正逐渐成为中下段直肠癌根治术首选的手术方式之一。
Background and Objective: The incidence of rectal cancer in the lower middle section is high in our country. How to improve the therapeutic effect of rectal cancer in the lower middle section has been paid attention. The aim of this study was to investigate the relationship between clinical and pathological features and prognosis of patients with rectal cancer in the lower and middle stages after radical operation. Methods: The clinical and pathological data of 599 middle and lower rectal cancer patients admitted to Cancer Center of Sun Yat-sen University from 1990 to 1999 were retrospectively analyzed. A total of 355 patients with abdominoperineal rection (APR) and 244 patients with lowanteriorresection (LAR) were included in the study. The survival rate was calculated by the life table method. The survival curves were compared by log-rank test, and the Cox proportional hazards model was used for multivariate analysis. Results: The overall 5-year overall survival rate was 70.7%. The APR and LAR were 67.5% and 75.2%, respectively (P = 0.026). Univariate analysis showed that local recurrence, perioperative blood transfusion, T staging, lymph node metastasis, operation mode, general type of tumor, type of tissue and tumor were related to the length of anal margin and the prognosis of patients with rectal cancer in the lower and middle stages (P <0.05). Multivariate analysis showed that local recurrence, perioperative blood transfusion, T stage and lymph node metastasis were independent prognostic factors (P <0.01). Conclusion: Local recurrence, perioperative blood transfusion, T staging and lymph node metastasis are important prognostic indicators in patients with rectal cancer in the middle and lower stages. LAR is gradually becoming the preferred surgical procedure for rectal cancer radical surgery.