老年直肠癌患者的术后肺转移相关临床病理因素研究

摘要

目的 探讨老年直肠癌患者在根治性手术后肺转移的发生率、时机和相关危险因素.方法 将2007年至2012年在北京医院胃肠外科接受根治性手术治疗的老年直肠癌患者纳入研究.观察患者术后转移和复发的发生情况,并对可能影响肺转移的临床病理特征进行单因素和多因素分析.结果 共有198例老年直肠癌患者进入研究队列,总体的5年无病生存期为76.8％.直肠癌根治术后最常见的转移部位是肺,其发病率为11.6％,其次才是肝脏(7.6％).从直肠手术到肺诊断的间隔时间要显著长于肝转移的时间(19个月和11个月,P=0.002).肿瘤位置、病理TNM分期和阳性的环周切缘被确定为肺转移的独立危险因素.结论 肺组织是老年直肠癌患者发生异时性转移的最常见部位.对于具有危险因素的患者,需要对其制定更严密的监测计划,以便尽早发现肿瘤转移或复发的情况.%Objective To investigate the incidence rate,timing and risk factors of metachronous pulmonary metastasis after curative resection in patients with rectal cancer.Methods A total of 198 patients with rectal cancer undergoing curative resection in gastroenterology surgery department of Beijing Hospital from 2007 to 2012 were enrolled in this retrospective study.The metachronous metastasis and recurrence were observed.Clinicopathologic factors which might be associated with postoperative pulmonary metastasis were analyzed by the univariate and multivariate analysis.Results The 5-year disease-free survival was 76.8％ in a total of 198 patients cohort.The most frequent metastatic sites were the lung(incidence of 11.6 ％)followed by liver(7.6 ％).Median interval from rectal surgery to diagnosis of pulmonary metastasis was much longer than that of hepatic metastasis(19 vs.11 months,P =0.002).Tumor location,current tumor-node-metastasis (TNM)stage,and a positive circumferential resection margin(CRM)were identified as the independent risk factors for pulmonary metastasis.The most common metachronous metastasis site for rectal cancer after curative surgery was the lung in elderly patients.Conclusions The lung is the most common metachronous metastatic site after curative surgery of rectal cancer in elderly patients.For patients with unfavorable risk profiles,a more intensive surveillance program is needed for the early detection of metachronous metastasis and recurrence.