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中华结直肠疾病电子杂志 ›› 2023, Vol. 12 ›› Issue (03) : 207 -213. doi: 10.3877/cma.j.issn.2095-3224.2023.03.006

论著

腹腔镜低位直肠癌经括约肌间切除术后的长期生存结果及预后因素分析
邱文龙, 刘军广, 胡刚, 梅世文, 汤坚强()   
  1. 100021 北京,国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院结直肠外科;065001 廊坊,国家癌症中心/国家肿瘤临床医学研究中心/河北中国医学科学院肿瘤医院结直肠外科
    100034 北京大学第一医院普通外科
  • 收稿日期:2022-07-06 出版日期:2023-06-25
  • 通信作者: 汤坚强
  • 基金资助:
    国家自然科学基金面上项目(81272710); 吴阶平医学基金会临床科研专项资助基金(320.6750.2021-04-02)

Long-term survival and risk factors analysis of laparoscopic intersphincteric resection for ultralow rectal cancers

Wenlong Qiu, Junguang Liu, Gang Hu, Shiwen Mei, Jianqiang Tang()   

  1. Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center of Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center of Cancer/Hebei Cancer Hospital, Chinese Academy of Medical Sciences, Langfang 065001, China
    Department of General Surgery, Peking University First Hospital, Beijing 100034, China
  • Received:2022-07-06 Published:2023-06-25
  • Corresponding author: Jianqiang Tang
引用本文:

邱文龙, 刘军广, 胡刚, 梅世文, 汤坚强. 腹腔镜低位直肠癌经括约肌间切除术后的长期生存结果及预后因素分析[J/OL]. 中华结直肠疾病电子杂志, 2023, 12(03): 207-213.

Wenlong Qiu, Junguang Liu, Gang Hu, Shiwen Mei, Jianqiang Tang. Long-term survival and risk factors analysis of laparoscopic intersphincteric resection for ultralow rectal cancers[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2023, 12(03): 207-213.

目的

研究腹腔镜经括约肌间切除术(Ls-ISR)用于距离肛缘5 cm以内的低位直肠癌的极限保肛手术的长期预后及危险因素。

方法

回顾性分析北京大学第一医院2012年~2018年间接受Ls-ISR治疗的患者临床资料及随访。Cox多因素回归分析总生存期(OS)和无病生存期(DFS)的影响因素,并根据预后危险因素,采用Log-rank检验法绘制Kaplan-Meier生存曲线。

结果

共177例患者纳入研究,中位随访时间60个月,累计局部复发6例,远处转移25例,死亡28例。1年、3年和5年的OS分别为96.0%、88.7%和85.2%,1年、3年和5年的DFS分别为94.4%、85.3%和80.0%,5年肿瘤特异性生存(CSS)达88.1%。单因素分析显示:年龄>60岁、脉管癌栓、神经侵犯、(y)pT3期和低分化是OS和DFS的共同危险因素,(y)pN+是DFS的危险因素。多因素分析中,年龄>60岁(HR=2.515,95%CI=1.121~5.642,P=0.025)、(y)pT3期(HR=2.591,95%CI=1.006~6.672,P=0.049)是OS的独立危险因素;年龄>60岁(HR=1.758,95%CI=1.061~2.912,P=0.028)、(y)pT3期(HR=2.010,95%CI=1.090~3.710,P=0.025)、(y)pN+(HR=2.347,95%CI=1.397~3.945,P=0.001)是DFS的独立危险因素。

结论

腹腔镜低位直肠癌ISR术后能获得令人满意的肿瘤学结果,年龄>60岁、(y)pT3分期、(y)pN+是影响长期生存的危险因素;术前应充分评估直肠癌的T分期及淋巴结转移情况。

Objective

Laparoscopic intersphincter resection (Ls-ISR) has been used as an extreme anal sparing surgery for low rectal cancer within 5 cm of the anal margin. However, the long-term oncological outcomes and risk factors affecting survival need further clarification.

Methods

We retrospectively analyzed patients treated with Ls-ISR between 2012 and 2018. Cox regression analysis of OS and DFS prognostic factors. Kaplan-Meier survival curve was plotted according to prognostic risk factors by Log-rank test.

Results

A total of 177 patients were included in the study, and the median follow-up time was 60 months. Among which, six patients had local recurrence, twenty-five patients had distant metastasis, and 28 patients died. The 1-year, 3-year and 5-year OS rates were 96.0%, 88.7% and 85.2%, respectively. The 1-year, 3-year and 5-year DFS were 94.4%, 85.3 % and 80.0%, respectively, and 5-year cancer-specific survival (CSS) was 88.1%. Univariate analysis showed that age over 60 years, lymph-vascular invasion, nerve invasion, (y)pT3 stage and low differentiation were common risk factors for OS and DFS, and (y)pN+ was a risk factor for DFS. In multivariate analysis, age over 60 years (HR=2.515, 95%CI=1.121~5.642, P=0.025) and (y)pT3 stage (HR=2.591, 95%CI=1.006~6.672, P=0.049) were independent risk factors for OS. Age over 60 years (HR=1.758, 95%CI=1.061~2.912, P=0.028), (y)pT3 stage (HR=2.010, 95%CI=1.090~3.710, P=0.025), (y)pN+ (HR=2.347, 95%CI=1.397~3.945, P=0.001) were independent risk factors for DFS.

Conclusions

Age and stage are important factors affecting the prognosis of low rectal cancer Ls-ISR. Preoperative evaluation of primary tumor stage and lymph node metastasis in order to develop the best surgical treatment strategy.

表1 临床基本信息
图1 177例患者的OS、DFS和CSS曲线
表2 影响OS的单因素和多因素分析
图2 生存曲线分析。2A:不同年龄的OS曲线;2B:不同(y)pT的OS曲线
表3 影响DFS的单因素和多因素分析
图3 无疾病生存曲线。3A:不同年龄DFS曲线;3B:不同(y)pT DFS曲线;3C:不同(y)pN的DFS曲线
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