Tỷ lệ sống sót và các yếu tố tiên lượng ở bệnh nhân ung thư đại trực tràng bên phải và bên trái giai đoạn I–IV: một nghiên cứu hồi cứu tại một trung tâm chưa lựa chọn

International Journal of Colorectal Disease - Tập 36 Số 12 - Trang 2683-2696 - 2021
Claudius E. Degro1, Richard Georg Strozynski1, Florian N. Loch1, Christian Schineis1, Fiona Speichinger1, Lucas D. Lee1, Katharina Beyer2, Johannes C. Lauscher1, Martin E. Kreis1, Carsten Kamphues1
1Department of General, Visceral and Vascular Surgery, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany
2Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, 10065, New York, NY, USA

Tóm tắt

Tóm tắtMục đích

Ung thư đại trực tràng đã thể hiện một sự thay đổi đáng kể trong vài thập kỷ qua với tỷ lệ ngày càng tăng của vị trí khối u bên phải so với bên trái. Trong nghiên cứu hiện tại, chúng tôi nhằm mục đích tiết lộ những khác biệt lâm sàng và bệnh lý giữa ung thư đại trực tràng bên phải (rCC) và bên trái (lCC) liên quan đến tỷ lệ tử vong và các yếu tố dự đoán kết quả.

Phương pháp

Tổng cộng, 417 bệnh nhân mắc ung thư đại tràng giai đoạn I–IV đã được phân tích trong nghiên cứu hồi cứu đơn trung tâm này. Tỷ lệ sống sót được đánh giá bằng phương pháp Kaplan–Meier và phân tích đơn/multi biến được thực hiện bằng mô hình hồi quy nguy cơ tỷ lệ Cox.

Kết quả

Nghiên cứu của chúng tôi không cho thấy sự khác biệt có ý nghĩa thống kê về tỷ lệ sống sót tổng thể giữa rCC và lCC giai đoạn I–IV (p = 0.354). Phân tích đa biến cho thấy trong nhóm rCC, kết quả tồi tệ nhất thuộc về bệnh nhân có điểm số ASA (Hiệp hội Gây mê Hoa Kỳ) IV (tỷ lệ nguy cơ [HR]: 16.0; CI 95%: 2.1–123.5), mức độ kháng nguyên phôi carcinoembryonic trong máu > 100 µg/l (HR: 3.3; CI 95%: 1.2–9.0), tỷ lệ hạch bạch huyết tăng 0.6–1.0 (HR: 5.3; CI 95%: 1.7–16.1), và khối u mức độ 4 (G4) (HR: 120.6; CI 95%: 6.7–2179.6) trong khi trong dân số lCC, điểm số ASA IV (HR: 8.9; CI 95%: 0.9–91.9), mức độ CEA trong máu 20.1–100 µg/l (HR: 5.4; CI 95%: 2.4–12.4), chuyển sang phẫu thuật mở bụng (HR: 14.1; CI 95%: 4.0–49.0), và các biến chứng phẫu thuật nghiêm trọng (Clavien-Dindo III–IV) (HR: 2.9; CI 95%: 1.5–5.5) được xác định là những yếu tố dự đoán làm giảm tỷ lệ sống sót tổng thể.

Kết luận

Khía cạnh bên không cho thấy ảnh hưởng đáng kể nào đến tiên lượng tổng thể của bệnh nhân ung thư đại tràng. Tuy nhiên, sự khác biệt giữa các nhóm và các yếu tố tiên đoán sống sót rõ ràng đã được xác định ở bệnh nhân rCC và lCC.

Từ khóa


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