直肠癌根治术后复发转移特点及危险因素分析

目的 研究直肠癌根治术后复发转移特点及其相关危险因素,为术后随访监测、防治复发转移提供依据.方法 回顾性研究中国医学科学院肿瘤医院1999年1月至2004年12月内初次根治手术治疗的1039例直肠癌病例资料,分析术后复发转移的特点及危险因素.结果 随访期间发生复发344例,占33.2％;常见的复发形式依次是局部复发（13.6％）、肝转移（6.9％）、肺转移（6.0％）.单因素分析显示：围手术期输血、病理大体类型、肿瘤大小、肿瘤位置、脉管瘤栓、癌结节、分化程度、T分期、N分期、M分期是复发转移的相关因素（P＜0.05）.多因素分析显示：术前CEA、肿瘤位置、脉管瘤栓、瘤结节、T分期、N分期是复发转移的独立危险因素（P＜0.05）.结论 直肠癌术后存在好发复发转移部位和与复发转移相关的独立危险因素;术后辅助放化疗等多学科综合治疗是降低直肠癌术后复发转移、延长生存期的有效手段.

Recurrence,metastases and risk factors of rectal cancer after radical surgery

Objective To characterize the recurrence, metastases and risk factors for patients with rectal cancer after radical surgery, for the sake of providing experience on follow-up, postoperative monitoring, precautionary and therapeutic methods for recurrence and metastases. Method We retrospectively studied 1039 patients with rectal cancer who initially received radical surgery in cancer hospital of Chinese Academy of Medical Science during January 1999 to December 2004. The features of recurrence were analyzed and multivariate analysis was performed to identify the risk factors. Result 344 （33.2%） patients developed recurrence or metastases in follow-up period. The common recurrent type of rectal cancer af- ter radical surgery was orderly local recurrence （ 13.6% ） , liver metastases （6. 9% ） and lung metastases （6. 0% ）. Uni- variate analysis showed that the factors associated with recurrence or metastases were perioperative blood transfusion, patho- logical type （macroscopic） , size, location of the tumor, vascular tumor embolus, tumor nodules, tumor differentiation, T stage, N stage and M stage （ all P 〈 0. 05）. Multivariate analysis showed that carcinoembryonic antigen （CEA） level, lo- cation of the tumor, vascular tumor embolus, tumor nodules, T stage and N stage were the independent risk factors for rec- tal cancer （P 〈0. 05）. Conclusion There are several common recurrent locations and independent risk factors for pa-tients with rectal cancer after radical surgery. Multidisciplinary therapy including postoperative radiotherapy and chemother- apy can efficaciously prevent local recurrence or distant metastasis and prolong survival time.