影响Ⅱ期结直肠癌患者预后的临床病理因素分析

Clinicopathological factors on the prognosis of patients with stage II colorectal cancer

目的分析影响Ⅱ期结直肠癌患者预后的临床病理因素，进一步探讨Ⅱ期结直肠癌患者进行辅助化疗的必要性。方法收集2000年1月至2005年12月中山大学附属第一医院（作者原工作单位）收治的符合纳入标准的255例Ⅱ期结直肠癌患者的临床资料。采用Kaplan-Meier法绘制患者的生存曲线，Log-rank法分析患者生存情况，对各种影响预后的因素分别进行单变量和多变量Cox回归分析。结果随访截至2010年4月23日，平均随访时间为（63±22）个月，中位生存时间为63个月。255例患者5年总生存率和无瘤生存率分别为85．3％和83．7％。术前无肠梗阻或肠穿孔患者的5年总生存率和无瘤生存率分别为86．9％和85．6％，高于术前出现肠梗阻或肠穿孔患者的72．7％和68．4％（√=4．546，4．573，P〈0．05）。手术切缘阴性患者的5年总生存率和无瘤生存率分别为85．5％和83．9％，高于手术切缘阳性患者的75．0％和75．0％（）（。=7．020，6．009，P〈0．05）。多因素分析结果提示术前肠梗阻或肠穿孔是Ⅱ期结直肠癌患者生存的独立影响因素（Wald=4．477，相对危险度为2．371，95％可信区间为1．066～5．275，P〈0．05）；接受辅助化疗和无辅助化疗患者的5年总生存率分别为87．3％和82．2％，无瘤生存率分别为86．0％和80．3％，两者比较，差异无统计学意义（P〉0．05）。结论术前肠梗阻或肠穿孔是影响Ⅱ期结直肠癌患者生存的独立危险因素；术后行辅助化疗并不能改善Ⅱ期结直肠癌患者的预后。

Objective To analyze the clinicopathological factors on the prognosis and investigate the necessity of adjuvant chemotherapy for patients with stage II colorectal cancer. Methods The clinical data of 255 patients with stage ]I colorectal cancer who were admitted to the First Affiliated Hospital of Sun Yat-Sen University from January 2000 to December 2005 were collected. The survival curve was drawn by Kaplan-Meier method, and the survival rate of the patients were analyzed by Log-rank test. Factors influencing the survival were analyzed by Cox regression model. Results All patients were followed up till April 23, 2010, and the mean time of follow-up was （63 -＋ 22） months. The median survival time was 63 months. The 5-year and tumor-free survival rates were 85.3% and 83.7% , respectively. The 5-year overall and tumor-free survival rates of patients without preoperative bowel obstruction or perforation were 86.9% and 85.6% , which were significantly higher than 72.7% and 68.4% of patients with preoperative bowel obstruction or perforation （ X^2 = 4. 546, 4. 573, P 〈 0.05）. The 5-year overall and tumor-free survival rates of patients with negative resection margin were 85.5% and 83.9% , which were significantly higher than 75.0% and 75.0% of patients with positive resection margin （ X^2 = 7. 020, 6. 009, P 〈 0.05）. The result of multivariate analysis revealed that preoperative bowel obstruetion or perforation were the independent risk factors for patients with stage H colorectal cancer （ Wald = 4. 477, relative risk = 2. 371, 95% confidence interval： 1. 066-5. 275, P 〈 0.05 ）. The 5-year overall and tumor-free survival rates were 87.3% and 86.0% for patients who received adjuvant chemotherapy, and were 82.2% and 80.3% for patients who did not receive adjuvant chemotherapy （ P 〉 0.05）. Conclusions Preoperative bowel obstruction or perfora- tion are independent risk factors for the survival of patients with stage II colorectal cancer. Adjuvant chemotherapy could not improve the prognosis of patients with stage lI colorectal cancer.