影响结直肠癌术后患者预后多因素分析

Multivariate Prognostic Analysis in Colorectal Cancer Patient after Surgery

目的:对临床结直肠癌术后患者预后的影响多因素进行探讨。方法:对本院2002年2月-2012年10月期间524例住院进行结直肠癌根治术后的患者的临床资料应用Cox分析法进行回顾性分析。结果:患者的人均复发转移率为23%(121/524),经手术治疗后2年内出现复发转移的患者占74%(90/121),3年内出现复发转移的患者占92%(111/121)。无复发组3年和5年患者的生存率分别为93%和86%,复发组分别为33%和20%。在对多因素进行分析结果显示,结直肠癌的分化程度、淋巴结转移和肿瘤位置是影响复发转移的高危因素,这其中又以淋巴结位置移动为对术后复发转移影响最大的因素。在分别进行的远处转移和局部复发多因素分析结果显示,分化程度、淋巴结转移、肿瘤部位与局部复发有着密切的关系,而远处转移则与肠壁浸润深度和淋巴结转移密切相关。对直肠癌多因素进行分析结果显示分化程度是影响术后复发的预后因素。结论:影响结直肠癌术后复发转移最主要的因素是淋巴结位置转移。术后远处转移的重要预后因素则是肿瘤的浸润深度,肿瘤分化程度低且位于直肠的临床患者术后局部复发的几率较大。

Objective： To discuss the prognosis muhivariate of patient after colorectal cancer surgery.Method： Clinical data of 524 inpatients who applied Cox analysis method had received colorectal cancer surgery in this Hospital from 2002 to 2012.Result： The average recurrence and metastasis rate was 23% （ 121/524 ） .Among them, patient of recurrence and metastasis within 2 years after the surgery accounts for 74% （ 90/121 ）, patient of recurrence and metastasis within 3 years after the surgery accounts for 92% （ 111/121 ） .For the patients＇ 3-year survival rate and 5-year survival rate： the group without recurrence and metastasis was 93% and 86% respectively, but the group with recurrence and metastasis was 33% and 20% respectively. It had been shown in the multivariate analysis that differentiation degree of colorectal cancer, lymphatic metastasis, and tumor site were the high risk factors causing recurrence and metastasis.Among the factors, lymphatic metastasis was the most significant factors causing recurrence and metastasis. Furthermore, it had been shown in the analysis of distant metastasis and analysis of local recurrence that differentiation degree of colorectal cancer, lymphatic metastasis, and tumor site had closed relation with local recurrence and depth of bowel wall invasion and lymphatic metastasis had closed relation with distant metastasis.It＇s been shown in the multivariate analysis of colorectal cancer that differentiation degree was the prognosis factor affecting recurrence after the surgery.Conclusion： The most significant factor causing recurrence and metastasis after colorectal cancer surgery is lymphatic metastasis. The significant prognosis factor causing distant metastasis after surgery is the invasion depth of tumor. The possibility rate of local recurrence of clinical patient whose cancer differentiation degree is lower and tumor is located in recta is comparatively high.