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目的探讨临床病理学特征和围手术期全身炎症状况与直肠癌病人术后存活率的关系,建立炎症相关直肠癌存活率预测评分系统。方法回顾性分析中山大学附属第六医院2007年6月至2012年8月就诊的382例I~Ⅲ期直肠癌病人临床资料、围手术期炎症状况指标和术后随访情况。结果全组病人的中位随访时间为46个月,1、3、5年总存活率分别为96.7%、85.6%、77.4%,1、3、5年无病存活率为86.9%、72.0%、68.1%。多因素分析结果提示,年龄、病理TNM分期、大体分型、脉管浸润情况和PNAG评分是Ⅰ~Ⅲ期直肠癌术后总存活率的独立影响因素。病理TNM分期、脉管浸润情况、PNAG评分是Ⅰ~Ⅲ期直肠癌术后无病存活率的独立影响因素。结论直肠癌病人术后存活率受临床病理学特征危险因素和全身炎症状况的影响,PNAG评分作为一项反映围手术期全身炎症状况的综合指标,对于存活率预测具有重要意义。
Objective To investigate the relationship between the clinicopathological features and perioperative systemic inflammatory status and the postoperative survival rate in patients with rectal cancer and establish a predictive score system for the survival rate of inflammatory related rectal cancer. Methods The clinical data of 382 patients with stage I ~ III rectal cancer attending the 6th Affiliated Hospital of Sun Yat-sen University from June 2007 to August 2012 were retrospectively analyzed. The perioperative inflammatory status and follow-up were also analyzed. Results The median follow-up time of all patients was 46 months. The overall survival rates at 1, 3 and 5 years were 96.7%, 85.6% and 77.4% respectively. The disease-free survival rates at 1, 3 and 5 years were 86.9% and 72.0% , 68.1%. Multivariate analysis showed that age, pathological TNM staging, gross classification, vascular invasion and PNAG score were independent prognostic factors of postoperative total survival in patients with stage Ⅰ ~ Ⅲ rectal cancer. Pathological TNM staging, vascular invasion, PNAG score is stage Ⅰ ~ Ⅲ rectal cancer disease-free survival rate after an independent factor. Conclusion The postoperative survival rate of patients with rectal cancer is influenced by the risk factors of clinical pathology and systemic inflammatory status. PNAG score is a comprehensive index reflecting systemic inflammatory status during perioperative period, which is of great significance for the prediction of survival rate.