Ⅱ期结直肠癌高危因素及辅助化疗的必要性探讨

Identification of high-risk factors and necessity of adjuvant chemotherapy for stage Ⅱ colorectal cancer

目的分析影响Ⅱ期结直肠癌患者预后的高危因素,初步探讨具有高危因素的患者行辅助化疗的必要性。方法对443例行结直肠癌根治术的Ⅱ期结直肠癌患者的临床病理资料进行统计,用Kaplan-Meier法计算生存率、绘制生存曲线。对高危因素进行Cox单因素和多因素模型分析,具有高危因素的患者再按有无辅助化疗分组分析、比较预后。结果术前伴有肠梗阻或穿孔、送检淋巴结数少于12枚、T4分期、切缘小于1 cm是影响Ⅱ期结直肠癌患者预后的高危因素,分组分析显示术前伴有肠梗阻或穿孔、送检淋巴结数少于12枚、T4分期的Ⅱ期大肠癌患者行辅助化疗后总生存率高于未化疗者。结论术前伴有肠梗阻或穿孔、送检淋巴结数少于12枚、T4分期、切缘小于1 cm是Ⅱ期结直肠癌患者预后不良的高危因素,具有前3种高危因素的患者可能从辅助化疗中获益。

Objective To identify the high risk factors in the prognosis of stage Ⅱ colorectal cancer, and analyze the necessity of adjuvant chemotherapy. Methods Four hundred and forty three patients with stage Ⅱcolon cancer who had received radical surgery in cancer center of Sun Yat - sen University were retrospectively analyzed. The overall surviv- al rate and survival curve were analyzed with the Kaplan - Meier method and Log - rank test, respectively. The univariate and multivariate Cox regression model were applied for high risk factors analysis. For patients with high - risk factors, prognosis was compared between patients with or without adjuvant chemotherapy. Results Univariate and multivariate regression analysis revealed that preoperative intestinal obstruction or perforation, number of sampled nodes less than 12, T4 stage and inadequate surgical margin were independent unfavorable prognostic factors for patient survival with stage Ⅱ colorectal cancer. During subgroup analysis, patients with the first three high - risk factors had higher 3 - year and 5 - year overall survival with adjuvant chemotherapy. Conclusion Preoperative intestinal obstruction or perforation, number of sampled nodes less than 12, T4 stage and inadequate surgical margin were high - risk prognostic factors. Furhtermore, patients with the first three factors can benefit from adjuvant chemotherapy.