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29例直肠乙状结肠印戒细胞癌的临床病理特征和诊疗分析

Clinicopathological characteristics, diagnosis, and treatment of 29 cases of signet ring cell carcinoma of the rectum and sigmoid colon

摘要:

目的:探讨直肠乙状结肠印戒细胞癌(SRCC)的临床病理特征和诊治疗效。方法:回顾性分析2008—2018年北京协和医院29例直肠乙状结肠SRCC患者的临床资料,分析患者的临床病理学特征、诊治效果和预后。结果:29例患者中,男17例,女12例,年龄为(48.7±14.3)岁。29例行术前结肠镜检查,其中20例(69.0%)呈肠壁环腔增厚表现,9例(31.0%)病变活检曾呈假阴性。在直肠超声和直肠磁共振检查中,误诊为炎性病变分别占25.0%(4/16)和17.6%(3/17)。29例患者中,13例行新辅助放化疗(NCRT),27例行根治性手术,8例行术后放疗。患者3年总生存率和3年无病生存率分别为54.0%和43.0%。未行NCRT(non-NCRT)组和NCRT组患者的3年总生存率分别为69.2%和46.2%,差异无统计学意义( P>0.05)。non-NCRT组和NCRT组患者的3年无病生存率分别为39.2%和45.8%,差异无统计学意义( P>0.05)。年龄<40岁、肿瘤纵径>5 cm为患者总生存时间缩短的独立影响因素(均 P<0.05)。 结论:直肠乙状结肠SRCC是罕见而具特殊临床表现的结直肠癌,其发病年龄轻、恶性度高、预后差。应加深对直肠乙状结肠SRCC的认识,关注分子肿瘤学进展,以期改善其诊治疗效。

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abstracts:

Objective:To investigate the clinicopathological characteristics and the therapeutic effects of signet ring cell carcinoma (SRCC) of rectum and sigmoid colon.Methods:Clinical data and the follow-up information of 29 SRCC patients treated in our tertiary care center from 2008 to 2018 were retrospectively reviewed. The clinicopathological features, diagnostic and therapeutic effects, and the prognostic outcomes were analyzed.Results:Among the 29 patients, 17 were male, 12 were female. The average age was (48.7±14.3) years. Colonoscopy revealed the features of diffuse circumferential thickening of the bowel wall in 20/29 cases (69.0%), while in 9/29 cases (31.0%), endoscopic biopsies showed false negative results. Twenty-five% (4/16) and 17.6% (3/17) lesions were misdiagnosed as the inflammatory changes by endoscopic rectal ultrasonography exam and rectal MRI scan, respectively. Thirteen of the 29 patients received the neoadjuvant chemoradiotherapy (NCRT), 27 patients underwent the radical resection surgeries, and 8 underwent the postoperative radiotherapy. With a median follow-up of 38.5 (3.5-87.0) months, the cumulative 3-years overall survival (OS) rate was 54.0%, and the cumulative 3-years disease-free survival (DFS) rate was 43.0%. The OS rates of patients treated with or without NCRT (non-NCRT) were 46.2% and 69.2%, respectively, without significant difference ( P>0.05). The DFS rates of patients treated with or without NCRT were 45.8% and 39.2%, respectively, without significant difference ( P>0.05). Parameters including age younger than 40 years and tumor size larger than 5 cm were independent potential risk factors for shortened OS ( P<0.05). Conclusions:SRCC of the rectum and sigmoid colon is a rare malignant tumor with special clinical manifestations. It is younger-onset, highly malignant and with very poor prognosis. Therefore, in-depth researches with focus upon the progress of molecular oncology are urgently needed to substantially improve the therapeutic effect of this disease.

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作者: 周皎琳 [1] 赵心怡 [2] 林国乐 [1] 邱辉忠 [1] 肖毅 [1] 吴斌 [1] 陆君阳 [1] 牛备战 [1] 孙曦羽 [1] 仲光熙 [1]
作者单位: 中国医学科学院北京协和医院基本外科 100730 [1] 清华大学附属北京清华长庚医院神经内科 清华大学临床医学院 102218 [2]
期刊: 《中华肿瘤杂志》2020年42卷10期 897-902页 MEDLINEISTICPKUCSCDCABP
栏目名称: 临床应用
DOI: 10.3760/cma.j.cn112152-20200228-00142
发布时间: 2020-11-09
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