• 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

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.