40岁以下青年人结肠癌的预后因素分析

Prognostic Factors in Young Patients with Colon Cancer

目的:根据96例青年结肠癌患者的临床病理特征,对患者术后生存进行单因素及多因素分析。方法:10年间手术治疗结肠癌723例。其中40岁以下青年人96例,占13.3%。R0术(病理根治)69例,占71.9%;R1(镜下切端阳性)4例,占4.1%;R2(大体标本切端阳性)23例,占24%。左半结肠切除术43例;右半结肠切除术37例;横结肠切除术9例;前切除术7例。结果:手术死亡率为0,54例患者于术后111个月内死于复发和转移。随访期间3例发生肝转移;1例发生肺转移;5例发生骨转移。患者总的中位生存时间为77.9±5.01个月。3、5、10年总生存率分别为66.68%,58.14%及46.54%。单因素分析表明患者的年龄、术式、肿瘤的根治度、术中输血、病理类型、肿瘤直径、肿瘤侵犯深度、淋巴结转移、远处转移、肝转移均为预后影响因素。多因素回归分析显示影响患者术后生存的独立因素仅为术中输血及淋巴结转移。结论:影响直肠癌患者术后生存的因素为患者的年龄、术式、肿瘤的根治度、术中输血、病理类型、肿瘤直径、肿瘤侵犯深度、淋巴结转移、远处转移,其中独立影响因素仅有术中输血及淋巴结转移。

Objective： To study 96 young patients with colon caneer seen in our cancer center to determine prognostic factors by univariate and muhivariate analysis. Methods： A total of 723 patients with colon cancer were treated surgically during a period of 10 years. Ninety-six of them were younger than 40 years old. R0, R1 and R2 operations were carried out in 69 patients （71.9% of the group younger than 40）, 4 patients （4.1%） and 23 patients （24%）, respeclively. Forty-three patients underwent left hemicolectomy, 37 patients had hemieolectomy on the right side, 9 patients underwent transverse colon resection and 7 patients had low anterior reseetion. Results： Intrasurgieal mortality was 0%, but 54 patients were dead within 111 months postoperatively due to recurrence or metastases of the tumor. Liver, lung and bone metastases oeeurred in 3, 1 and 5 patients, respectively. The median survival lime for all patients was 77.9±5.01 months and the overall 3-, 5- and 10-year survival rates were 66.68%, 58.14% and 46.54%, respectively. In the univariate survival analysis, patient age, type of surgery performed, extent of resection, blood transfusion, histological type, diameter of the tumors, depth of tumor invasion, lymphatie invasion, distant metastases, liver metastases and TNM stage are predictors of survival in young patients with colon cancer. In the Cox-Regression analysis, bln.d transfusion and lymphatic invasion were determined to be independent prognostie faetors for survival. Conclusions： Based on univariate analysis we found that patient age, type of surgery performed, extent of resection,blood transfusion, histological type, diameter of the tumors, depth of tumor invasion,lymphatic ivasion, distant metastases and TNM stage were predictors of survival. Blood transfusion and ,lymphatic ivasion were the only statistically significant prognostic： factors by multivariate analysis.