不同年龄组大肠癌预后多因素分析的比较

Multivariate analysis of prognostic factors in colorectal cancer patients with different ages

目的研究青年、中年和老年组大肠癌预后的影响因素,指导临床治疗。方法对842例行根治术后的大肠癌患者,按发病年龄分为青年组(≤40岁)、中年组(41～64岁)和老年组(≥65岁)。用SPSS软件分别对3组患者的35个临床病理因素进行单因素生存分析和多因素Cox比例风险模型回归分析。结果842例大肠癌的5,10,15年生存率分别为66.3%、54.2%和48.5%,青年组大肠癌的5,10年生存率分别为53.0%和42.7%,低于其他年龄组患者。多因素分析显示,Dukes分期和家族肿瘤史为青年和中年组大肠癌患者的共同影响因素;慢性便秘是中年组大肠癌预后的独立影响因素;肠梗阻、手术时间、转移淋巴结数为老年组大肠癌的预后因素。病程(从出现症状到手术时间)不是影响青年组大肠癌的主要原因。青年组DukesA期患者的5,10年生存率分别为82.6%和64.5%,B期分别为73.3%和67.4%,C期分别为37.3%和27.0%,D期分别为33.3%和22.2%。青年组A期和B期患者生存率与中老年组相近,但C期和D期的生存率低于中老年组。有家族肿瘤史的青年组患者预后好,其5,10年生存率分别为73.1%和64.5%,显著高于无家族肿瘤史患者的48.1%和37.3%。结论不同年龄组大肠癌预后影响因素有差异,青年组大肠癌的生存率明显低于其他年龄组。在青年组,大肠癌Dukes分期晚和无家族肿瘤史的患者预后差,病程不是影响预后的因素,青年组大肠癌患者预后差与就诊时间晚、延误诊断无关。

Objective To investigate the prognostic factors of young, middle-age and old-age colorectal cancer patients in order to improve the treatment in the future. Methods Colorectal cancer patients（ n=842） who had undergon curative resection were divided into three groups according their age： young group（≤40 years）, middle-age group（41 to 64 years ） and old group （≥65 years）. Thirty-five clinical factors in the three groups were analyzed and compared by univariate survival and multivariate analysis. Cox proportional hazards regression model was used with SPSS statistic software. Results The overall 5-, 10-and 15-year survival rates were 66.3%, 54.2% and 48.5% respectively. The 5-and 10-year survival rates were 53.0% and 42.7% in the young group, which were lower than those in the other two groups. Cox proportional hazards regression model demonstrated that Dukes stage and family history of cancer were common prognostic factors in both young and middle-age groups; chronic constipation was an independent prognostic factor in middle-age group; bowel obstruction, length of operating time and number of metastatic lymph nodes were prognostic factors in the older group. In the young group, the symptomatic duration was not demonstrated as a prognostic factor. The 5- and 10-year survival rates were 82.6% and 64.5% in Dukes A stage; 73.3% and 67.4% in B stage; 37.3% and 27.0% in C stage; 33.3% and 22.2% in D stage. The survival rates in Dukes A and B stages were similar, but in Dukes C and D stages they were lower than those of the middle-age and older groups if the patient had the same stage of disease. in the young colorectal cancer patients with family cancer history, the 5- and 10-year survival rates were 73.1% and 64.5 %, which were better than those of patients without it （48.1% and 37.3 % ）. Conclusion In young colorectal cancer patients, the survival rate is lower than those in the middle-age and old patients. Family cancer history and/or advanced Dukes stage are poor prognostic factors, whereas the symptomatic duration is not demonstrated as a poor prognostic factor. The prognostic factors affecting the survival after surgical treatment may be different in different age groups of colorectal cancer patients.