影响晚期大肠癌预后的多因素分析

Multivariate regression analysis on prognostic factors for advanced colorectal carcinoma

背景与目的:晚期大肠癌的预后因素分析有利于其个体化的综合治疗,而国内外相关文献报道不多。本研究探讨晚期大肠癌临床病理特征及不同治疗方法对其生存的影响。方法:对北京协和医院近5年化疗的143例晚期大肠癌患者采用单因素和多因素回归分析方法分析其预后影响因素。结果:143例晚期大肠癌患者中位生存期20.0个月。单因素分析表明,确诊晚期时转移器官数目、腹膜转移、癌胚抗原(CEA)≥50ng/ml、乳酸脱氢酶(LDH)及碱性磷酸酶(ALP)升高、肠道外转移灶综合治疗、转移灶曾行根治性切除术为预后影响因素(P<0.05),新药联合分子靶向治疗、两种新药序贯化疗、单种新药化疗、不规范应用新药化疗及氟尿嘧啶类化疗组的中位生存期分别为26.0、24.0、21.0、9.0、14.0个月,前3组分别与后2组间生存期差异具有显著性(P<0.05)。回归分析显示转移器官数目、ALP升高、全身治疗方案、肠道外转移灶综合治疗、转移灶根治性切除术是影响晚期大肠癌患者生存的独立因素。结论:确诊晚期时单器官转移、ALP正常、肠道外转移灶综合治疗、转移灶的根治性切除、新一代化疗药物的规范应用及联合分子靶向治疗是提示晚期大肠癌患者预后好的独立因素。

Background and purpose： The prognostic analysis of advanced colorectal carcinoma may help for its individualized comprehensive therapy. However, relative prognostic factors are still not determined .. The present study investigated the impacts of the clinical and pathological characteristics, different therapeutic strategies on prognosis of patients with advanced colorectal carcinoma. Methods： A total of 143 patients with advanced colorectal carcinoma were analyzed retrospectively, by univariate and multivariate analyses to evaluate the prognostic factors. Results： The median survival of 143 patients was 20.0 months. Kaplan-Meier estimate showed that the number of involved organs at diagnosis, peritoneal metastasis, carcinoembryonic antigen（CEA） ≥50 ng/ml, elevation of lactate dehydrogenase（LDH） and alkaline phosphatase （ ALP）, muhimodality-treatment for metastases, radical resection of metastases were all predictors of survival（ P 〈 0.05）. The median survival of patients treated with new drugs plus molecular targeted medicines, regular chemotherapy with both oxaliplatin and irinotecan, regular chemotherapy with single oxaliplatin or irinotecan, irregular chemotherapy with new drugs, chemotherapy with fluorouracil alone were 26.0, 24.0, 2l. 0, 9.0 and 14.0 months respectively. Univariate analysis revealed significant differences in survival between the former three therapy modes and the latter two modes respectively （P 〈 0.05）. Multivariate regression analysis showed that the number of involved organs, elevation of ALP, systemic treatment regimen, muhimodality-treatment of metastases, and radical resection of metastases were independent prognostic factors. Conclusions： It is found that only one involved organ, normal alkaline phosphatase, muhimodality-treatment of metastases, radical resection of metastases, regular chemotherapy with oxaliplatin and irinotecan, and combined molecular targeted therapy are the independent proznostic factors for overall survival of oatients with advanced colorectal carcinoma.