Objective: To explore the effect of unfavorable histological features on the clinical outcomes of patients receiving radical resection of colorectal cancer. Methods: A retrospective analysis of patients with colorectal cancer who received radical surgery between January 2013 and December 2015 at Department of General Surgery, Peking Union Medical College Hospital was performed. The impact of unfavorable histological features on the oncological outcomes of patients with lymph node-negative colorectal cancer were analyzed.A total of 167 patients were enrolled, including 98 males and 69 females with age of (63.6±11.6) years. Observation indicators included age, T stage, lymphovascular invasion, perineural invasion, tumor deposits, number of lymph node dissection, degree of differentiation, tissue type, and circumferential margin. Univariate analysis was performed with χ(2) test and multivariate analysis was performed with Cox regression model. Results: Univariate analysis showed that positive circumferential margins (CRM), tumor deposits and age were associated with disease free survival (DFS) rate; positive CRM, age, tumor deposits, and lymph nodes dissection less than 12 were significantly associated with overall survival (OS) rate (all P<0.05). Multivariate analysis showed that over 70 years of age (HR=1.053, 95% CI: 1.013 to 1.095, P=0.009), poorly differentiated adenocarcinoma (HR=7.572, 95%CI: 1.815 to 31.587, P=0.005), tumor deposits (HR=4.711, 95% CI: 1.809 to 12.264, P=0.002), mucinous adenocarcinoma (HR=3.063, 95% CI: 1.003 to 9.354, P=0.049), lymphovascular invasion (HR=2.885, 95% CI: 1.062 to 7.832, P=0.038), and nerve infiltration (HR=6.610, 95% CI: 1.037 to 42.122, P=0.046) were adverse prognostic factors of DFS rate; poorly differentiated adenocarcinoma (HR=12.200, 95% CI: 1.985 to 74.972, P=0.007), tumor nodules (HR=5.379, 95% CI: 1.636 to 17.685, P=0.006), over 70 years of age (HR=1.062, 95% CI: 1.013 to 1.114, P=0.013), and perineural invasion (HR=8.043, 95% CI: 1.026 to 63.055, P=0.047) were adverse prognostic factors of OS rate. There was no significant difference in the 3-year DFS rate and 3-year OS rate between T1-2 group and T3-4 group (P>0.05). Conclusion: Over 70 years of age, poorly differentiated adenocarcinoma, mucinous adenocarcinoma, tumor nodules, lymphovascular invasion, and perineural invasion are independent adverse prognostic factors of lymph node-negative colorectal cancer.
目的： 探讨不良组织学特征对淋巴结阴性结直肠癌根治术治疗效果的影响。 方法： 回顾性收集2013年1月至2015年12月北京协和医院基本外科收治并行根治性手术的结直肠癌患者资料，分析临床不良组织学特征对淋巴结阴性结直肠癌患者远期生存的影响。共入组167例患者，男性98例，女性69例。年龄(63.6±11.6)岁。观察指标包括年龄、T分期、脉管浸润、神经浸润、肿瘤种植、清扫淋巴结数目、分化程度、组织类型、环周切缘。单因素分析采用χ(2)检验，多因素分析采用Cox回归模型。 结果： 单因素分析结果显示，环周切缘阳性、肿瘤种植和年龄与无病生存率相关，环周切缘、年龄、T分期、肿瘤种植和淋巴结清扫数目与总体生存率相关(P值均<0.05)。多因素分析结果显示，年龄≥70岁(HR＝1.053，95% CI：1.013～1.095，P＝0.009)、低分化腺癌(HR＝7.572，95% CI：1.815～31.587，P＝0.005)、肿瘤种植(HR＝4.711，95% CI：1.809～12.264，P＝0.002)、黏液腺癌(HR＝3.063，95% CI：1.003～9.354，P＝0.049)、脉管瘤栓(HR＝2.885，95% CI：1.062～7.832，P＝0.038)、神经侵犯(HR＝6.610，95% CI：1.037～42.122，P＝0.046)是无病生存率的独立不良预后因素；低分化腺癌(HR＝12.200，95% CI：1.985～74.972，P＝0.007)、肿瘤种植(HR＝5.379，95% CI：1.636～17.685，P＝0.006)、年龄≥70岁(HR＝1.062，95% CI：1.013～1.114，P＝0.013)和神经侵犯(HR＝8.043，95% CI：1.026～63.055，P＝0.047)是总体生存率的独立不良预后因素。T1～2期患者与T3～4期患者比较，3年无病生存率及3年总体生存率无明显差异(P值均>0.05)。 结论： 年龄≥70岁、低分化腺癌、黏液腺癌、肿瘤种植、脉管瘤栓、神经侵犯是淋巴结阴性结直肠癌患者的独立不良预后因素。.
Keywords: Colorectal neoplasms; Histology; Oncological efficacy; Radical surgery.