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目的探讨病理分期对新辅助治疗直肠癌患者预后的影响。方法回顾性分析2004年1月至2011年12月期间我院接受新辅助治疗+根治性手术治疗的152例中晚期直肠癌患者的临床资料和术后生存状况。采用Kaplan-Meier法计算各亚组3年无病生存率(DFS),并用Log-rank检验进行比较。采用单因素和多因素Cox比例风险回归模型进行预后分析。结果全部患者的3年DFS为84.3%。T、N分期、淋巴结转移率、局部浸润因素、术前CEA、CA19-9水平的各亚组之间的3年DFS比较,差异有统计学意义(P<0.05)。N分期、淋巴结转移率、局部浸润因素和术前CEA水平是影响直肠癌患者预后的独立影响因素(P<0.05)。结论直肠癌新辅助治疗后仍然推荐进行手术治疗,术后病理分期与患者的预后密切相关,其中N分期、淋巴结转移率、局部浸润因素是其独立影响因素。
Objective To investigate the effect of pathological staging on the prognosis of patients with rectal cancer treated with neoadjuvant. Methods The clinical data and postoperative survival of 152 patients with advanced and rectal cancer treated with neoadjuvant and radical surgery in our hospital from January 2004 to December 2011 were analyzed retrospectively. Three-year disease-free survival (DFS) was calculated for each subgroup using the Kaplan-Meier method and compared using Log-rank test. Prognostic analysis was performed using univariate and multivariate Cox proportional hazards regression models. Results All patients had a 3-year DFS of 84.3%. There was significant difference of 3-year DFS between T, N stage, lymph node metastasis rate, local infiltration factors, preoperative CEA and CA19-9 levels in all subgroups (P <0.05). N staging, lymph node metastasis, local infiltration factors and preoperative CEA levels were independent prognostic factors in patients with rectal cancer (P <0.05). Conclusions Neoadjuvant treatment of rectal cancer is still recommended for surgical treatment. The postoperative pathological staging is closely related to the prognosis of patients. Among them, N stage, lymph node metastasis rate and local infiltration factors are their independent influencing factors.