Ⅱ期结肠癌患者的预后分析和辅助化疗评价

Analysis of Prognostic Factors and the Value of Adjuvant Chemotherapy of Stage Ⅱ Colon Cancer

目的探讨Ⅱ期结肠癌根治术后的预后影响因素,评价术后辅助化疗在Ⅱ期结肠癌中的价值。方法回顾性分析我院2001年1月至2004年1月收治的134例接受根治性手术切除的Ⅱ期结肠癌患者的临床资料,生存率计算采用Kaplan-Meier法,采用Log-rank法进行生存比较,组间对比采用χ2检验。结果全组的中位无瘤生存期和生存期均未达到,3年无瘤生存率和生存率分别为91.01%和93.23%。单因素分析显示:T4和淋巴结解剖数目≤10个为不良预后因素(P<0.05);全组共85.07%(114/134)的患者接受了术后辅助化疗,年龄和是否具有预后不良因素是影响患者接受辅助化疗的主要原因(P<0.05);辅助化疗组和未化疗组的3年无瘤生存率和3年生存率均无统计学意义(P>0.05),但辅助化疗组中具有不良预后因素的患者显著多于未化疗组(P=0.047)。结论肿瘤局部浸润深度和淋巴结解剖不全是Ⅱ期结肠癌最重要的预后影响因素,大多数Ⅱ期结肠癌患者均接受辅助化疗,建议对存在不良预后影响因素的Ⅱ期结肠癌患者给予辅助化疗。

Objective To explore the prognostic factors and evaluate the value of adjuvant chemotherapy in the patients with stage Ⅱ colon cancer. Methods Between Jan. 2001 and Jan. 2004,134 patients with stage Ⅱ colon cancer who had received radical surgery were retrospectively analyzed. The overall and disease-free survival rates were calculated with the Kaplan-Meier method and compared with Log-rank test. Differences between different groups were compared by Chi-Square method. Results Up to the last follow up, the median disease free survival and overall survival were not reached. The 3-year disease-free and overall survival rates were 91.01% and 93.23 %, respectively. In univariate analysis, T4 and the number of dissected lymph nodes ≤ 10 were poor-prognostic factors （ P 〈 0.05 ）. 85.07% （114/134） patients received adjuvant chemotherapy. Age and whether the patient having poor-prognostic factors significantly influenced the application of adjuvant chemotherapy （P 〈 0.05 ）. Although more patients in the adjuvant chemotherapy group had poor-prognostic factors （ P = 0.047 ）, the 3-year disease free and overall survival rates between the two groups had no difference（P 〉 0.05 ）. Conclusion The depth of tumor invasion and incomplete resection of lymph node are the most important poor-prognostic factors. Adjuvant chemotherapy is recommended to the patients with poor-prognostic factors.