遗传性非息肉病性结直肠癌与散发性结肠癌的临床特征及生存率对比分析

摘要

Objective Different types of colon cancer have a big difference in their clinical features and prognosis.The article aimed to provide theoretical basis for the diagnosis and treatment of colon cancer patients by analyzing the differences of clinical features and survival rates between hereditary non-polyposis colorectal cancer (HNPCC) and sporadic colon cancer.Methods Retrospective analysis was made on 22 HNPCC cases and 105 cases of sporadic colon cancer in our hospital from January 2007 to January 2012 to get the clinical features and prognosis by comparative analysis.Results Compared with sporadic group, the early onset(under 40 years) (36.37％ vs 9.52％), mucinous adenocarcinoma (59.09％ vs 17.14％), low differentiation (45.45％ vs 16.19％), TNM stage (III+IV) (54.55％ vs 26.66％), lymph node metastasis (81.82％ vs 57.14％), multiple primary carcinoma (36.36％ vs 7.62％) and parenteral tumor (22.73％ vs 5.71％) were higher in HNPCC group, but the 5 year survival rate was lower in HNPCC group, and there were significant differences between two groups(P<0.05);but there were no significant difference in gender, tumor size, location and operation (P>0.05) between two groups.Multiple primary tumors were independent risk factors for survival in HNPCC group (P<0.05), lymph node metastasis and TNM stage were independent risk factors for survival sporadic group (P<0.05).Conclusion Compared with sporadic colon cancer, HNPCC is characterized by early onset, low differentiation, high incidence of multiple primary tumors and poor prognosis, which is of great importance to find HNPCC patients or suspicious HNPCC patients.%目的 结肠癌类型不同,其临床特征及预后存在较大差异.文中分析遗传性非息肉病性结直肠癌(HNPCC) 与散发性结肠癌在临床特点以及生存率等差异,为结肠癌患者的诊治提供理论依据. 方法 回顾性分析沈阳医学院附属中心医院2007年1月至2012年1月收治的22例HNPCC及105例散发性结肠癌患者临床资料,对比分析其临床特点及预后.结果 与散发性结肠癌患者相比,HNPCC患者发病≤40岁所占比例更高(36.37％ vs 9.52％),并以黏液腺癌(59.09％ vs 17.14％)和低分化(45.45％ vs 16.19％)为主、TNM分期以(Ⅲ+Ⅳ)为主(54.55％ vs 26.66％)、淋巴转移(81.82％ vs 57.14％)、多原发癌(36.36％ vs 7.62％)和肠外肿瘤(22.73％ vs 5.71％)多见、5年生存率更低(22.73％ vs 54.29％),且差异均有统计学意义(P<0.05);而在性别、肿瘤大小、部位及手术方式等方面差异无统计学意义(P>0.05). 多原发肿瘤是影响HNPCC患者生存的独立危险因素(P<0.05);淋巴转移和TNM分期是影响散发组生存的独立危险因素(P<0.05). 结论 与散发性结肠癌比较,HNPCC具有发病年龄早、分化低、多原发肿瘤发生率高、预后差等特点,上述特征对于发现HNPCC或疑似患者具有重要意义.