Ⅱ期结肠癌患者的预后分析

Analysis of prognostic factors in patients with 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127例接受根治性手术切除的Ⅱ期结肠癌患者的临床资料并进行随访,采用Kaplan-Meier法进行生存分析,采用Log-rank法进行生存比较,COX比例风险模型进行多因素分析。结果单因素分析显示,年龄、大体分型、组织学类型、侵犯邻近器官、脉管浸润、淋巴结解剖个数及术前CEA为不良预后因素(P<0.05);进一步多因素分析显示,组织学类型和脉管浸润是影响生存的独立预后因素。全组共85.0%(108/127)的患者接受了术后辅助化疗,辅助化疗组和未化疗组的5年生存率差异无统计学意义(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=0.000)。结论Ⅱ期结肠癌的预后与多种因素有关,组织学类型和脉管浸润是影响生存的独立预后因素。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 to evaluate the value of adjuvant chemotherapy in the patients with stage Ⅱ colon cancer.Methods From January 2000 to December 2005,127 patients with stage Ⅱ colon cancer who had received radical surgery were retrospectively analyzed and followed up,the survival rates were estimated by Kaplan-Meier method and compared with Log-rank method.COX proportional hazards model was used for multivariate analysis.Results Univariate analysis showed that the age,gross type,histological type,violation of nearby organs,vascular invasion,lymph nodes dissection and preoperative CEA were factors of adverse prognostic（P0.05）;further multivariate analysis showed that histological type and vascular invasion were independent prognostic factors affecting survival.The total of 85.0%（108/127） of patients received adjuvant chemotherapy,5-year survival rate of adjuvant chemotherapy group and no chemotherapy group was not significantly related（P0.05）,but the number of the patients with adverse prognostic factors in adjuvant chemotherapy group was significantly more than no chemotherapy group（P=0.000）.Conclusion The prognosis of stage Ⅱ colon cancer is affected by a variety of factors,histological type and vascular invasion are independent prognostic factors affecting survival.The patients of stage Ⅱ colon cancer with poor prognosis need adjuvant chemotherapy.