628例Ⅱ期和Ⅲ期结肠癌患者根治术后复发转移的危险因素分析

Analysis of prognostic factors after radical resection in 628 patients with stage Ⅱ or Ⅲ colon cancer

目的探讨Ⅱ、Ⅲ期结肠癌根治术后肿瘤复发转移的危险因素。方法回顾性分析628例Ⅱ、Ⅲ期结肠癌根治术患者的临床资料，以Kaplan-Meier法比较生存差异，Cox单因素和多因素分析复发转移的危险因素。结果中位随访58个月，随访期内，179例患者出现复发转移。全组患者的5年无病生存率和总生存率分别为70．3％和78．5％。单因素分析结果显示，年龄、吸烟状况、T分期、淋巴结转移情况、有无癌结节、肿瘤大体形态、TNM分期、分化程度、是否有脉管瘤栓、术后辅助化疗方案、术前和术后CEA水平、术前和术后CA19-9水平以及是否为双原发癌与Ⅱ、Ⅲ期结肠癌根治术后肿瘤的复发转移相关（均P〈0．05）。多因素分析结果显示，区域淋巴结转移、术后辅助化疗方案为单药氟尿嘧啶类、TNM分期为Ⅲ期、术前CEA和CA19-9升高是影响Ⅱ、Ⅲ期结肠癌根治术后肿瘤复发转移的独立危险因素（均P〈0．05）。结论区域淋巴结转移、术后辅助化疗方案为单药氟尿嘧啶类、TNM分期为Ⅲ期、术前CEA和CA19-9升高是影响Ⅱ、Ⅲ期结肠癌根治术后肿瘤复发转移的独立危险因素。

Objective To analyze the clinicopathologic factors related to recurrence and metastasis of stage Ⅱ or Ⅲ colon cancer after radical resection. Methods The clinical and pathological data of 628 patients with stage Ⅱ or Ⅲ colon cancer after radical resection from Jan. 2005 to Dec. 2008 in our hospital were retrospectively reviewed and analyzed. Results The overall recurrence and metastasis rate was 28.5% （179/628）. The 5-year disease-free survival （DFS） rate was 70.3% and 5-year overall survival （OS） rate was 78.5%. Univariate analysis showed that age, smoking intensity, depth of tumor invasion, lymph node metastasis, TNM stage, gross classification, histological differentiation, blood vessel tumor embolus, tumor gross pathology, multiple primary tumors, preoperative and postoperative serum concentration of CEA and CA19-9, and the regimen of adjuvant chemotherapy were correlated to recurrence and metastasis of colon cancer after radical resection. Multivariate analysis showed that regional lymph node metastasis, TNM stage, the regimen of postoperative adjuvant chemotherapy, and preoperative serum concentration of CEA and CA19-9 were independent factors affecting the prognosis of colon cancer patients. Conclusion Regional lymph node metastasis, TNM stage, elevated preoperative serum concentration of CEA and CA19-9, the regimen of postoperative adjuvant chemotherapy with single fluorouracil type drug are independent risk factors of recurrence and metastasis in patients with stage Ⅱ-Ⅲ colon cancer after radical resection.