摘要目的 探讨直肠癌术后复发的时间规律及远期预后评估指标.方法 将1979年5月至2006年11月诊治的直肠癌术后发生复发的314例患者按照复发间隔期(从第一次手术至复发的时间)的长短分为3组(<3年、3～5年、5年),用Kaplan-Meier法计算术后生存率,以COX模型进行多变量分析.结果 直肠癌术后在5年内复发的病例占92.0%(288/314),其中3年内复发的病例为78.7%(247/314),以2年内复发率最高达65.9%(207/314);3～5年复发病例为13.3%(41/314);5年以上复发的病例为8.0%(26/314).单因素分析显示无病生存期、肿瘤大体、病理类型、Dukes分期、浸润深度、淋巴结转移和远处转移等因素对直肠癌术后复发患者的累计生存率有显著影响,多因素分析显示无病生存期和Dukes分期是直肠癌术后复发患者累计生存率的独立影响因素.无病生存期和无进展生存期均与术后复发患者的生存期呈正相关.结论 直肠癌术后2年内应进行密集复查,第3年适当加强随访,无病生存期和无进展生存期可作为直肠癌复发患者远期治愈和预后的最佳预测指标.

abstractsObjective To investigate the regular pattern and prognostic evaluation of patients with recurrent rectal cancer after resection. Methods Three hundred and fourteen cases with recurrent rectal cancer after resection treated between May 1979 and November 2006 were classified into three groups according to the recurrence intervals ( <3 years, 3-5 years, 5 years). The survival rates and prognosis in the three groups were analyzed and compared retrospectively. Results Of the 314 patients, the cancer relapsed in 247 cases (78.7%) in less than 3 years, and the recurrence occurred predominantly within 2 years(207 cases, 65.9% ) after the operation. The neoplasm in 41 cases (13.3%) recurred in 3-5 years after the operation, and 26 cases (8.3%) in more than 5 years after the resection. Disease-free interval, Dukes stage, neoplasm gross type, histological type, T stage, lymphatic and distant metastasis were associated with the prognosis on univariate analysis. And disease-free interval and tumor Dukes stage were independent prognostic factors for survival rate on multivariate analysis. Disease-froe interval and progressionflee survival were related positively with survival time. Conclusions The rectal cancer patients should be followed-up intensively for 2 years after the operation and moderately from then on. Disease-free interval and progression-free survival could be taken as the best predictors of long-term cure and prognosis.