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目的探讨国内结直肠癌的临床治疗现状和对预后的影响。方法回顾性分析2006年1月至2012年7月间军事医学科学院附属医院收治的813例结直肠癌患者的临床资料,初诊无转移者499例,其中接受根治性手术484例,根据患者既往接受治疗的医院分为A级(省级和省级以上医院)和B级(地市级和地市级以下医院)。比较不同级别医院、不同治疗模式对结直肠癌患者预后的影响。结果 A级医院患者手术后中位无病生存期(DFS)和中位总生存期(OS)显著优于B级医院(P=0.01,P=0.05)。A级医院高危Ⅱ期和Ⅲ期患者接受辅助化疗比例显著高于B级医院(P=0.01)。A级医院患者辅助化疗的中位DFS和中位OS较B级医院明显延长(P<0.05,P=0.04)。254例接受根治手术的直肠癌患者中,有99例接受了围手术期放疗,Ⅰ期、Ⅱ期和Ⅲ期患者接受围手术期放疗比例分别为30.8%、25.5%和47.4%。338例术后复发转移的患者中,原发灶位于左半结肠患者的中位OS优于右半结肠者(P=0.05)。266例Ⅳ期患者中,接受根治性原发灶和转移灶切除手术患者的预后明显优于原发灶姑息性切除联合解救化疗、单纯解救化疗、仅接受局部治疗和未接受任何治疗的患者,差异有统计学意义(P=0.00)。结论不同级别医院在根治性手术和辅助化疗中存在较大差异,直接影响患者的预后。Ⅳ期患者应把握根治性原发灶和转移灶的切除机会,以获得长期生存。
Objective To explore the clinical treatment of colorectal cancer in China and its impact on prognosis. Methods The clinical data of 813 patients with colorectal cancer admitted to the Affiliated Hospital of Academy of Military Medical Sciences from January 2006 to July 2012 were analyzed retrospectively. Among the 499 newly diagnosed patients without metastasis, 484 patients underwent radical surgery, The treatment of the hospital is divided into A-level (provincial and provincial hospitals) and B (prefecture-level and prefecture-level hospitals). To compare the different levels of hospitals, different treatment modalities prognosis of patients with colorectal cancer. Results The median disease-free survival (DFS) and median overall survival (OS) of Grade A patients were significantly better than those of Grade B hospitals (P = 0.01, P = 0.05). Grade A hospitals at high risk of phase Ⅱ and Ⅲ patients receiving adjuvant chemotherapy was significantly higher than the proportion of Class B hospitals (P = 0.01). The median DFS and median OS of adjuvant chemotherapy in patients in Grade A hospital were significantly longer than those in Grade B hospitals (P <0.05, P = 0.04). Of the 254 rectal cancer patients undergoing radical surgery, 99 received perioperative radiotherapy and patients in stage I, II and III received perioperative radiotherapy in 30.8%, 25.5% and 47.4%, respectively. Among the 338 patients with recurrent and metastatic disease, the median OS of patients with primary colon in the left colon was superior to that of the right colon (P = 0.05). In 266 patients with stage Ⅳ, the prognosis of patients undergoing radical primary resection and metastases resection was significantly better than that of primary palliative resection combined with rescue chemotherapy. Only patients who received local treatment and did not receive any treatment, The difference was statistically significant (P = 0.00). Conclusion Different levels of hospitals in radical surgery and adjuvant chemotherapy there is a big difference, a direct impact on the prognosis of patients. Ⅳ patients should grasp the radical removal of primary and metastatic lesions opportunities to obtain long-term survival.