老年结直肠癌的临床和病理特点及其预后分析

Clinicopathological characteristics and prognosis of senile colorectal cancer

目的探讨老年结直肠癌患者的临床、病理及预后特点。方法收集2005年1月至2009年12月间于湖南中医药大学第一附属医院普外科诊断为结肠癌且接受手术治疗的患者的完整资料,进行生存分析和预后的多因素分析。共选取84例老年患者,其中男性48例,女性36例,平均年龄71.38岁,与同期75例中青年结肠癌患者的临床和病理资料进行比较。应用SPSS 19.0统计学软件进行数据分析,以P<0.05有统计学意义。各组间相关因素比较采用χ2检验,应用Kaplan-Meier法进行生存分析,多因素分析采用Cox风险比例回归模型计算。结果 84例老年结直肠癌患者中,患者临床表现以血便为主。直肠是最常见出血部位。病理组织类型以腺癌为主(占86.90%)。多因素分析结果显示,年龄、手术方式、病理分型、组织学分化程度、TNM分期、化疗是影响预后重要的独立因素。与中青年结肠癌患者(年龄<65岁)相比,肿瘤大体分型(2=10.652,P=0.005)、组织学类型(2=29.466,P<0.001)、分化程度(2=26.806,P=0.033)、淋巴结转移(2=6.963,P=0.031)、肿瘤浸润深度(2=7.983,P=0.018)、TNM分期(2=9.720,P=0.021)及远处转移方面(2=5.165,P=0.023),差异有统计学意义。结论老年直肠癌患者的病程发展缓慢、肿瘤分化程度较高,早期根治性手术治疗可以取得较好的疗效及预后,化疗是保护性因素,早期诊疗是提高结直肠癌患者总体生存率的关键。

Objective To explore the clinicopathological features and prognosis of colorectal cancer in senile patients. Methods The datas of eolorectal cancer patient underwent surgery in the first affiliated hospital of hunan university of Chinese medicine from January 2005 to December 2009 were collected. 84 older patients were involved in our study（48 males,36 females. The mean age was 71.38 years）. Seventy-five cases of young and middle-aged patients were taken for comparison. The statistical analysis was performed with SPSS Statistics 19.0. All the discontinuous independent variables were tested with Pearson＇ s Z2-test. Survival rates were calculated using the Kaplan-Meier method. And the correlation between multiple factors and the prognosis of patients was analyzed using Cox analysis. P 〈 0.05 was considered to be statistically significant. Results Clinical manifestation in the 84 older patients was mainly performed as bloody stools. The rectum was the most common location for bleeding （44. 05% ）. Adenoearcinoma was the dominant histopathological type （86. 90% ）. Multi-factor analysis results showed that age, operating methods, pathological type, histological differentiation, TNM stage, chemotherapy were all the important independent prognostic factors. Compared with young and middle-aged patients with colon cancer（ 〈 65 years） , the tumor gross type（z2 = 10. 652, P = 0. 005 ）, histological type （ Z2 = 29. 466, P 〈 0. 001 ）, differentiation （ X2 = 26. 806, P = 0. 033 ） ,lymph node metastasis （ X2 = 6. 963, P = 0.031 ）, tumor infiltration depth （ X2 = 7. 983, P = 0. 018） ,TNM stage （ 2 = 9. 720, P = 0. 021 ） and tumor distant metastasis （ X2 = 5. 165, P = 0. 023 ） showed statistical differences. Conclusions Elderly patients with colorectal cancer had slower progression and better differentiation. Early radical surgery could achieve good curative effect and prognosis. Chemotherapy is a protective factor. Early examination and treatment are significant to impove the survival rate for senilepatients with colorcctal cancer.