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进展期低位直肠癌侧方淋巴结转移的临床研究

Clinic study of lateral lymph node metastasis in advanced lower rectal cancer

摘要:

目的 分析进展期低位直肠癌侧方淋巴结转移的危险因素,探讨侧方淋巴结转移对局部复发及预后的影响.方法 回顾性分析行根治性切除+侧方淋巴结清扫的96例进展期低位直肠癌的临床资料,探讨侧方淋巴结转移与临床病理特征、局部复发和预后的相关性.结果 进展期低位直肠癌侧方淋巴结转移率为14.6%(14/96).肿瘤直径≥5 cm者侧方淋巴结转移率为25.0%,明显高于肿瘤直径<5 cm者的7.1%(P<0.05).侵犯肠壁周径1/4、2/4和3/4者侧方淋巴结转移率分别为6.3%、6.7%和12.0%,明显低于侵犯肠壁周径4/4者的70.0%(P<0.05).低分化直肠癌侧方淋巴结转移率为30.0%,明显高于高分化和中分化直肠癌的4.5%和9.1%(P<0.05).进展期低位直肠癌根治性切除术后局部复发率为18.8%(18/96).侧方淋巴结转移阳性者术后局部复发率为64.3%,明显高于侧方淋巴结转移阴性者的11.0%(P<0.05).Kaplan-Meier生存分析显示,侧方淋巴结转移阳性患者平均生存期为(38.0±6.7)个月,明显短于无侧方淋巴结转移的(80.9±2.1)个月(P<0.05).结论 肿瘤直径、侵犯肠壁周径和肿瘤分化程度是进展期低位直肠癌侧方淋巴结转移的重要危险因素.侧方淋巴结转移与进展期低位直肠癌局部复发及预后密切相关.

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abstracts:

Objective To evaluate the risk factors of lateral lymph node metastasis in advanced lower rectal cancer and its correlation with local recurrence and prognosis.Methods Data from 96 consecutive patients with advanced lower rectal cancer underwent curative surgery with lateral dissection were retrospectively analyzed.The correlations of lateral lymph node metastasis with clinicopathologic characteristics,local recurrence and prognosis were investigated.Results Lateral lymph node metastasis was observed in 14.6(14/96)of the cases.In 40 patients with tumor diameter≥5 cm,10(25.0%)patients were found with lateral lymph node metastasis;while in the other 56 patients,only 4(7.1%)cases were found with lateral lymph node metastasis(P<0.05).Lateral lymph node metastasis was more frequent in patients whose tumor infihrated full range of the intestinal wall(70%)than patients with 3/4,2/4 and 1/4 intestinal wall was infiltrated(12.0%,6.7%and 6.3%,respectively)(P<0.05).Lateral lymph node metastasis rate of poorly differentiated carcinomas was significantly higher than those of moderate and well-differentiated ones(30%vs.9.1%and4.5%,P<0.05).Local recurrence occurred in 18.8%(18 of 96 cases)of patients.Local recurrence in patients with positive lateral lymph node metastasis was 64.3%,while 11.0%in those without lateral lymph node metastasis(P<0.05).Kaplan-Meier survival analysis showed significant improvements in median survival for patients with negative lateral lymph node metastasis over patients with lateral lymph node metastasis(80.9±2.1 vs.38±6.7 months,log-rank P<0.05).Conclusions Tumor diameter,degree of tumor infiltration and histological differentiation are significant risk factors of lateral lymph node metastasis in advanced lower rectal cancer.Lateral lymph node metastasis is an important predictor of local recurrence and prognosis of patients.

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