• 四川大學華西醫(yī)院肛腸外科(成都610041);

目的　 初步驗證英國結直腸醫(yī)師協(xié)會結直腸癌術后風險評估模型(The colorectal cancer model of the Association of Coloproctology of Great Britain and Ireland,ACPGBI-CCM)的準確性，探討其與臨床風險預測指標間的關系。
方法 　回顧性分析2007年4月至2007年7月期間四川大學華西醫(yī)院肛腸外科治療組收治的診斷明確的結直腸癌患者。通過ACPGBI-CCM為每一位納入研究的患者計算死亡率預測值，并以死亡率預測值中位數(shù)為界，將納入患者分為低風險組與高風險組，比較2組間不同風險因子的差異; 然后對評估指標進行分層分析，探討其與術后死亡率預測值的關系。
結果 　研究期間本治療組共收治了99例診斷明確的結直腸癌患者，其中有67例符合納入條件，平均年齡60.09歲，男34例，女33例； 右半結腸癌15例，左半結腸癌9例，直腸癌43例; Dukes分期: A期0例，B期37例，C期24例，D期6例。術后30 d內(nèi)的實際死亡例數(shù)為0。ACPGBI-CCM預測的死亡率為0.77%～25.75%，中位值為3.36%，以預測死亡率≤3.36%為低風險組(34例)，預測死亡率 gt;3.36%為高風險組(33例)，高風險組的死亡率預測值明顯高于低風險組〔(8.86±4.51)% vs (1.76±0.68)%,P＜0.01〕。高風險組與低風險組間患者年齡、內(nèi)科合并癥、術前有無化療、ASA分級、術中腫瘤是否切除及手術持續(xù)時間差異均有統(tǒng)計學意義(P＜0.01)； 2組間腫瘤并發(fā)癥、Dukes分期、TNM分期及術后疼痛差異也均有統(tǒng)計學意義(P＜0.05); 2組間性別、既往腹部手術史、腫瘤距肛緣位置、腫瘤部位、分化程度、術后住院時間及總住院時間差異均無統(tǒng)計學意義(P gt;0.05)。進一步對各風險評估指標進行分析，發(fā)現(xiàn)不同年齡、有無內(nèi)科合并癥、術前化療、不同ASA分級及腫瘤是否切除會導致不同的死亡率，其差異具有統(tǒng)計學意義(P＜0.01); 不同Dukes分期和分化程度會引起不同的死亡率，其差異亦有統(tǒng)計學意義(P＜0.05); 而不同的性別、有無既往腹部手術史、腫瘤并發(fā)癥、不同TNM分期及不同腫瘤部位之間死亡率風險預測值差異均無統(tǒng)計學意義(P gt;0.05)。
結論 　ACPGBI-CCM的臨床適用性在單一大容量的醫(yī)療中心研究中得到肯定，但其預測效果會高估死亡率，這可能是由于地域和人文差異帶來的結果。進一步分析發(fā)現(xiàn)，合并癥、是否行新輔助治療或輔助治療可能是結直腸癌患者術后生存質(zhì)量的獨立預測因子，這需要進一步的臨床分層次研究來證實。

引用本文： 曹霖,汪曉東,陳珊珊,李立. ACPGBI結直腸癌術后風險評估模型臨床應用的初步探索. 中國普外基礎與臨床雜志, 2008, 15(9): 646-651. doi: 復制

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1. 　Shike M, Winawer SJ, Greenwald PH, et al. Primary prevention of colorectal cancer. The WHO Collaborating Centre for the Prevention of Colorectal Cancer [Ｊ]. Bull World Health Organ, 1990; 68(3)∶377.
2. 　Ries LAG, Eisner MP, Kosary CL, et al. SEER cancer statistics review, 1975-2002 [EB/OL]. http://seer.cancer.gov/csr/1975_2002/, 2005-04/2008-04-20.
3. 　Edwards BK, Howe HL, Ries LA, et al. Annual report to the nation on the status of cancer, 1973-1999, featuring implications of age and aging on U.S. cancer burden [Ｊ]. Cancer, 2002; 94(10)∶2766.
4. 　Aschele C, Lonardi S. Multidisciplinary treatment of rectal cancer: medical oncology [Ｊ]. Ann Oncol, 2007; 18(11)∶1908.
5. 　Tekkis PP, Poloniecki JD, Thompson MR, et al. Operative mortality in colorectal cancer: prospective national study[Ｊ]. BMJ, 2003; 327(7425)∶1196.
6. 　Metcalfe MS, Norwood MG, Miller AS, et al. Unreasonable expectations in emergency colorectal cancer surgery [Ｊ]. Colorectal Dis, 2005; 7(3)∶275.
7. 　Ferjani AM, Griffin D, Stallard N, et al. Newly devised scoring system for prediction of mortality in patients with colorectal cancer: a prospective study [Ｊ]. Lancet Oncol, 2007; 8(4)∶317.
8. 　Sobin LH, Wittekind C Eds. TNM classification of malignant tumours [M]. 6th ed. New York: Wiley, 2002∶55-87.
9. 　呂東昊, 汪曉東, 陽川華, 等. 結直腸腫瘤多學科協(xié)作診治模式的數(shù)據(jù)庫初期建設現(xiàn)狀 [Ｊ]. 中國普外基礎與臨床雜志, 2007; 14(6)∶713.
10. 　汪曉東, 曹霖, 羅德云, 等. 多學科協(xié)作診治模式下運行結直腸癌綜合治療的臨床對照研究 [Ｊ]. 中國普外基礎與臨床雜志, 2008; 15(1)∶63.
11. 　汪曉東, 馮碩, 游小林, 等. 結直腸腫瘤多學科協(xié)作診治模式下的隨訪體系建設 [Ｊ]. 中國普外基礎與臨床雜志, 2007; 14(6)∶709.
12. 　Valenti V, Hernandez-Lizoain JL, Baixauli J, et al. Analysis of POSSUM score and postoperative morbidity in patients with rectal cancer undergoing surgery [Ｊ]. Langenbecks Arch Surg, 2008; [Epub ahead of print].
13. 　Al-Homoud S, Purkayastha S, Aziz O, et al. Evaluating operative risk in colorectal cancer surgery: ASA and POSSUM-based predictive models [Ｊ]. Surg Oncol, 2004; 13(2-3)∶83.
14. 　張建生. POSSUM、(P、Cr)-POSSUM、APGBI評分系統(tǒng)預測結直腸癌術后死亡率的研究 [Ｊ]. 大腸肛門病外科雜志, 2005; 11(2)∶102.
15. 　Bennett-Guerrero E, Hyam JA, Shaefi S, et al. Comparison of PPOSSUM risk-adjusted mortality rates after surgery between patients in the USA and the UK [Ｊ]. Br J Surg, 2003; 90(12)∶1593.
16. 　Piccirillo JF, Tierney RM, Costas I, et al. Prognostic importance of comorbidity in a hospital-based cancer registry [Ｊ]. JAMA, 2004; 291(20)∶2441.
17. 　Read WL, Tierney RM, Page NC, et al. Differential prognostic impact of comorbidity [Ｊ]. J Clin Oncol, 2004; 22(15)∶3099.
18. 　Yancik R, Ganz PA, Varricchio CG, et al. Perspectives on comorbidity and cancer in older patients: approaches to expand the knowledge base [Ｊ]. J Clin Oncol, 2001; 19(4)∶1147.
19. 　Ko C, Chaudhry S. The need for a multidisciplinary approach to cancer care [Ｊ]. J Surg Res, 2002; 105(1)∶53.
20. 　Brosens RP, Oomen JL, Glas AS, et al. POSSUM predicts decreased overall survival in curative resection for colorectal cancer [Ｊ]. Dis Colon Rectum, 2006; 49(6)∶825.
  1. 1. 　Shike M, Winawer SJ, Greenwald PH, et al. Primary prevention of colorectal cancer. The WHO Collaborating Centre for the Prevention of Colorectal Cancer [Ｊ]. Bull World Health Organ, 1990; 68(3)∶377.
  2. 2. 　Ries LAG, Eisner MP, Kosary CL, et al. SEER cancer statistics review, 1975-2002 [EB/OL]. http://seer.cancer.gov/csr/1975_2002/, 2005-04/2008-04-20.
  3. 3. 　Edwards BK, Howe HL, Ries LA, et al. Annual report to the nation on the status of cancer, 1973-1999, featuring implications of age and aging on U.S. cancer burden [Ｊ]. Cancer, 2002; 94(10)∶2766.
  4. 4. 　Aschele C, Lonardi S. Multidisciplinary treatment of rectal cancer: medical oncology [Ｊ]. Ann Oncol, 2007; 18(11)∶1908.
  5. 5. 　Tekkis PP, Poloniecki JD, Thompson MR, et al. Operative mortality in colorectal cancer: prospective national study[Ｊ]. BMJ, 2003; 327(7425)∶1196.
  6. 6. 　Metcalfe MS, Norwood MG, Miller AS, et al. Unreasonable expectations in emergency colorectal cancer surgery [Ｊ]. Colorectal Dis, 2005; 7(3)∶275.
  7. 7. 　Ferjani AM, Griffin D, Stallard N, et al. Newly devised scoring system for prediction of mortality in patients with colorectal cancer: a prospective study [Ｊ]. Lancet Oncol, 2007; 8(4)∶317.
  8. 8. 　Sobin LH, Wittekind C Eds. TNM classification of malignant tumours [M]. 6th ed. New York: Wiley, 2002∶55-87.
  9. 9. 　呂東昊, 汪曉東, 陽川華, 等. 結直腸腫瘤多學科協(xié)作診治模式的數(shù)據(jù)庫初期建設現(xiàn)狀 [Ｊ]. 中國普外基礎與臨床雜志, 2007; 14(6)∶713.
  10. 10. 　汪曉東, 曹霖, 羅德云, 等. 多學科協(xié)作診治模式下運行結直腸癌綜合治療的臨床對照研究 [Ｊ]. 中國普外基礎與臨床雜志, 2008; 15(1)∶63.
  11. 11. 　汪曉東, 馮碩, 游小林, 等. 結直腸腫瘤多學科協(xié)作診治模式下的隨訪體系建設 [Ｊ]. 中國普外基礎與臨床雜志, 2007; 14(6)∶709.
  12. 12. 　Valenti V, Hernandez-Lizoain JL, Baixauli J, et al. Analysis of POSSUM score and postoperative morbidity in patients with rectal cancer undergoing surgery [Ｊ]. Langenbecks Arch Surg, 2008; [Epub ahead of print].
  13. 13. 　Al-Homoud S, Purkayastha S, Aziz O, et al. Evaluating operative risk in colorectal cancer surgery: ASA and POSSUM-based predictive models [Ｊ]. Surg Oncol, 2004; 13(2-3)∶83.
  14. 14. 　張建生. POSSUM、(P、Cr)-POSSUM、APGBI評分系統(tǒng)預測結直腸癌術后死亡率的研究 [Ｊ]. 大腸肛門病外科雜志, 2005; 11(2)∶102.
  15. 15. 　Bennett-Guerrero E, Hyam JA, Shaefi S, et al. Comparison of PPOSSUM risk-adjusted mortality rates after surgery between patients in the USA and the UK [Ｊ]. Br J Surg, 2003; 90(12)∶1593.
  16. 16. 　Piccirillo JF, Tierney RM, Costas I, et al. Prognostic importance of comorbidity in a hospital-based cancer registry [Ｊ]. JAMA, 2004; 291(20)∶2441.
  17. 17. 　Read WL, Tierney RM, Page NC, et al. Differential prognostic impact of comorbidity [Ｊ]. J Clin Oncol, 2004; 22(15)∶3099.
  18. 18. 　Yancik R, Ganz PA, Varricchio CG, et al. Perspectives on comorbidity and cancer in older patients: approaches to expand the knowledge base [Ｊ]. J Clin Oncol, 2001; 19(4)∶1147.
  19. 19. 　Ko C, Chaudhry S. The need for a multidisciplinary approach to cancer care [Ｊ]. J Surg Res, 2002; 105(1)∶53.
  20. 20. 　Brosens RP, Oomen JL, Glas AS, et al. POSSUM predicts decreased overall survival in curative resection for colorectal cancer [Ｊ]. Dis Colon Rectum, 2006; 49(6)∶825.