摘要
目的评价直肠癌系膜转移与其肿瘤生物学特性的关系。方法选择1997年1月至1998年12月按全直肠系膜切除原则切除的直肠腺癌328例。将直肠周围系膜癌扩散形式划分为三类:直肠系膜结节状癌转移(包括血管旁明显淋巴结转移和系膜脂肪内明显癌结节);直肠系膜非结节状癌转移(微灶样转移)包括:系膜内散在癌细胞积聚、淋巴管静脉内癌栓、末梢小血管和神经浸润、腹膜/肠壁孤立微小种植;直肠系膜癌浸润包括:癌周临近组织脏器浸润、自主神经支干受累、直肠癌环周被膜受累、直肠癌旁脂肪浸润。分析直肠癌系膜转移方式与肿瘤分期、分化、部位的关系。结果直肠系膜结节状转移率为59.8%。直肠系膜非结节状转移率36%,其中单独微灶转移率11.6%。直肠癌环周被膜受累38.1%,其中18例为T2期,直肠癌旁脂肪浸润43.3%,其中26例为T2期。根治术后5年无病生存率总体为63.9%,按TNM分期,T1～3期分别为89.7%、75.7%、52.6%;而按有无直肠癌系膜转移则分别为49.6%和91.4%。结论直肠癌系膜转移形式与恶性肿瘤生物学特点和不良预后密切相关,可作为传统病理分期的补充和术后辅助治疗的选择指标。
Objective To assess the relationship between the incidence and prognostic significance of mesoreetal involvement. Methods 328 eases of rectal cancer reseeted with total or subtotal mesoreetal excision in our hospital from Jan. 1997 to Dee. 1998 were followed up and analyzed in this study. The neoplastic foei were identified at the pathologic examination of the mesoreetum. Results Neoplastic mesoreetal metastasis was found in 234 eases （71.3%）; node involvement in 59.8% and microscopic foei involvement in 36 % of all eases （isolated in 11.6%, mierofoei alone without any kind of other mesoreetal involvement）. Microscopic deposits were found in 10. 3% of TNM Stage I tumors, in 18.4% of Stage I and in 45.1% of Stage I cancers. Five-year disease-free survival rate （49.6% vs. 91.4%） were observed in patients with mesoreetal involvement, compared with those without deposits. Conclusion The incidence of neoplastic foei in the mesoreetum seem to affect prognosis, even in early staged tumors. The presence of mesoreetal foei should be considered an index in modifying the conventional staging of the rectal tumor.
出处
《四川大学学报（医学版）》
CAS
CSCD
北大核心
2006年第2期295-297,共3页
Journal of Sichuan University(Medical Sciences)
关键词
直肠肿瘤
转移
生物学
Rectal neoplasm Metastasis Biology
