پديد آورندگان :
نصيري، شيرزاد دانشگاه علوم پزشكي و خدمات بهداشتي درماني تهران - بيمارستان دكتر شريعتي - گروه جراحي عمومي , سروش، احمدرضا دانشگاه علوم پزشكي و خدمات بهداشتي درماني تهران - بيمارستان دكتر شريعتي - گروه جراحي عمومي , كرم نژاد، مازيار دانشگاه علوم پزشكي و خدمات بهداشتي درماني تهران - بيمارستان دكتر شريعتي - گروه جراحي عمومي , مهرخاني، فرهاد دانشگاه علوم پزشكي تهران
چكيده فارسي :
ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺳﺮﻃﺎﻥ ﮐﻮﻟﻮﺭﮐﺘﺎﻝ، ﻳﮑﻲ ﺍﺯ ﺷﺎﻳﻌﺘﺮﻳﻦ ﺑﺪﺧﻴﻤﻲ ﻫﺎ ﻣﻲ ﺑﺎﺷﺪ. ﺗﺸﺨﻴﺺ ﺯﻭﺩﻫﻨﮕﺎﻡ ﻭ ﺩﺭ ﻣﺮﺍﺣﻞ ﺍﺑﺘﺪﺍﻳﻲ ﺗﺄﺛﻴﺮ ﺯﻳﺎﺩﻱ ﺩﺭ ﭘﻴﺶ ﺁﮔﻬﻲ ﺑﻴﻤﺎﺭﺍﻥ ﺩﺍﺭﺩ. ﺩﺭ ﻣﻄﺎﻟﻌﺔ ﺣﺎﺿﺮ، ﺗﺄﺛﻴﺮ ﻋﻮﺍﻣﻠﻲ ﻣﺜﻞ ﻣﺮﺣﻠﻪ ﺑﻴﻤﺎﺭﻱ، ﺳﻦ، ﺟﻨﺲ، ﻣﺮﺣﻠﻪ ﻭ ﻣﺤﻞ ﺗﻮﻣﻮﺭ ﺑﺮ ﭘﻴﺶ ﺁﮔﻬﻲ ﺑﻴﻤﺎﺭﺍﻥ ﺑﺎ ﺳﺮﻃﺎﻥ ﮐﻮﻟﻮﺭﮐﺘﺎﻝ ﺩﺭ ﻃﻲ ﺩﻭﺭﺓ ﭘﻨﺞ ﺳﺎﻟﻪ ﺑﺮﺭﺳﻲ
ﺷﺪﻩ ﺍﺳﺖ.
ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺑﻴﻤﺎﺭﺍﻧﻲ ﮐﻪ ﺑﺎ ﺗﺸﺨﻴﺺ ﺳﺮﻃﺎﻥ ﮐﻮﻟﻮﺭﮐﺘﺎﻝ ﺩﺭ ﺑﻴﻦ ﺳﺎﻝ ﻫﺎﻱ 1378 ﺍﻟﻲ 1381 ﺩﺭ ﺑﺨﺶ ﺟﺮﺍﺣﻲ ﺑﻴﻤﺎﺭﺳﺘﺎﻥ ﺷﺮﻳﻌﺘﻲ ﺗﻬﺮﺍﻥ ﺗﺤﺖ ﻋﻤﻞ ﺟﺮﺍﺣﻲ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻪ ﺑﻮﺩﻧﺪ، ﻭﺍﺭﺩ ﻣﻄﺎﻟﻌﻪ ﺷﺪﻧﺪ. ﺑﻴﻤﺎﺭﺍﻥ ﺑﺎ ﻋﻮﺩ ﺳﺮﻃﺎﻥ ﮐﻮﻟﻮﺭﮐﺘﺎﻝ ﻳﺎ ﺑﺎ ﺳﺎﺑﻘﺔ ﺷﻴﻤﻲ ﺩﺭﻣﺎﻧﻲ ﻗﺒﻞ ﺍﺯ ﻋﻤﻞ ﺣﺬﻑ ﺷﺪﻧﺪ ﻭ 109 ﺑﻴﻤﺎﺭ ﺗﺤﺖ ﺁﻧﺎﻟﻴﺰ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻨﺪ. ﻣﻨﺤﻨﻲ ﻫﺎﻱ ﺑﻘﺎﺀ ﺗﻮﺳﻂ ﺭﻭﺵ Kaplan-Meier ﺗﺮﺳﻴﻢ ﺷﺪﻧﺪ. ﻓﺎﮐﺘﻮﺭﻫﺎﻱ ﺑﺮﺭﺳﻲ ﺷﺪﻩ ﺷﺎﻣﻞ ﺳﻦ،ﺟﻨﺲ، ﻣﺮﺣﻠﻪ TNM، ﻣﺘﺎﺳﺘﺎﺯ ﺩﻭﺭﺩﺳﺖ، ﺩﺭﺟﻪ، ﺗﻬﺎﺟﻢ ﻋﺮﻭﻗﻲ ﻭ ﻟﻨﻔﺎﻭﻱ، ﻣﺤﻞ ﺗﻮﻣﻮﺭ، ﺳﻄﺢ CEA ﻗﺒﻞ ﺍﺯ ﻋﻤﻞ ﻭ ﺗﺴﺖ ﻫﺎﻱ ﻋﻤﻠﮑﺮﺩ ﮐﺒﺪﻱ ﺑﻮﺩﻧﺪ.ﺁﻧﺎﻟﻴﺰ ﭼﻨﺪ ﻣﺘﻐﻴﺮﻩ ﺑﺮ ﺍﺳﺎﺱ Cox-Regression Analysis ﺍﻧﺠﺎﻡ ﺷﺪ.
ﻳﺎﻓﺘﻪ ﻫﺎ: ﻣﻴﺎﻧﮕﻴﻦ ﻃﻮﻝ ﻋﻤﺮ ﺑﻴﻤﺎﺭﺍﻥ 2/8 ± 42/8 ﻣﺎﻩ ﺑﻮﺩ. ﺑﻘﺎﺀ 1 ﻭ 3 ﻭ 5 ﺳﺎﻟﻪ ﺑﻪ ﺗﺮﺗﻴﺐ 72 ﺑﻮﺩﻧﺪ. ﺑﺮﺍﺳﺎﺱ ﺁﻧﺎﻟﻴﺰ ﺗﮏ ﻣﺘﻐﻴﺮﻩ، ﺳﻦ )P<0.001(، ﻣﺮﺣﻠﻪ )P<0.001(، ﻋﻤﻖ ﻧﻔﻮﺫ )P=0.015(، ﺩﺭﮔﻴﺮﻱ ﻏﺪﺩ ﻟﻨﻔﺎﻭﻱ )P=0.016(، ﻣﺘﺎﺳﺘﺎﺯ ﺩﻭﺭﺩﺳﺖ )P<0.001(، ﺩﺭﺟـﻪ )P=0.005( ﻭ ﺳﻄـﺢ CEA ﺳـﺮﻡ ﻗﺒـﻞ ﺍﺯ ﻋﻤـﻞ ﺑﺎﻻﻱ P=0.021) 5 ng/ml( ﺩﺭ ﻣﻴـﺰﺍﻥ ﺑﻘـﺎﺀ ﺑﻴﻤـﺎﺭﺍﻥ ﻣـﻮﺛﺮ ﺑـﻮﺩﻧﺪ. ﺩﺭ ﺁﻧﺎﻟﻴـﺰ Cox-Regression، ﺳﻦ )P<0.001(، ﻣـﺮﺣﻠﻪ
)P=0.001( ﻭ ﺩﺭﺟﻪ )P=0.008( ﺑﻪ ﻋﻨﻮﺍﻥ ﻓﺎﮐﺘﻮﺭﻫﺎﻱ ﻏﻴﺮ ﻭﺍﺑﺴﺘﻪ ﺩﺭ ﻣﻴﺰﺍﻥ ﺑﻘﺎﺀ ﺑﻴﻤﺎﺭﺍﻥ ﻣﺸﺨﺺ ﺷﺪﻧﺪ.
ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺳﻦ، ﻣﺮﺣﻠﻪTNM ، ﻣﺘﺎﺳﺘﺎﺯ ﺩﻭﺭﺩﺳﺖ، ﺩﺭﺟﻪ، ﺗﻬﺎﺟﻢ ﻋﺮﻭﻗﻲ ﻭ ﻟﻨﻔﺎﻭﻱ ﻭ ﺳﻄﺢ CEA ﻗﺒﻞ ﺍﺯ ﻋﻤﻞ، ﻓﺎﮐﺘﻮﺭﻫﺎﻱ ﻣﻬﻢ ﺩﺭ ﭘﻴﺶ ﺁﮔﻬﻲ ﻣﻴﺰﺍﻥ ﺑﻘﺎ ﺑﻴﻤﺎﺭﺍﻥ ﺳﺮﻃﺎﻥ ﮐﻮﻟﻮﺭﮐﺘﺎﻝ ﭘﺲ ﺍﺯ ﺟﺮﺍﺣﻲ ﻣﻲ ﺑﺎﺷﻨﺪ.
چكيده لاتين :
Introduction & Objective: Colorectal carcinoma is one of the most prevalent cancers. Early diagnosis and diagnosis in primary stages are important in patient’s prognosis. In this study we evaluated factors such as age, sex, stage and tumor location in colorectal patients in five year peroid. Materials & Methods: From the cancer database of a single referral institution, Shariati Hospital 109 patients who had resection of colorectal cancer from 1999 to 2002 were identified. Cases with recurrent colon cancer or previous history of neoadjuvant chemotherapy were excluded. Survival curves were constructed using the kaplan-meier method. The factors that were used included: age, sex, TNM stage, T-status, nodal status, distant metastasis, grade, lymphatic and vascular invasion, tumor location, preoperative CEA level and liver function tests. Multivariate analysis of factors was conducted using cox-regression analysis. Results: The mean survival time for all patients was 42.8±2.8) months. The overall 1, 3, 5 year survival rates were 72%, 54%, 47% respectively. The single variable analysis, patients age (P
