老年结直肠癌根治性切除患者的预后分析

Prognosis analysis of radical resection for colorectal cancer in the elderly

目的 探讨老年结直肠癌患者根治切除术后的预后影响因素.方法 回顾分析北大医院和北京医院2008年7月至2011年7月收治的年龄65岁以上,行根治性结直肠癌切除术的416例患者的临床病理资料.采用Kaplan-Meier法进行生存分析,Log-rank检验进行生存率比较;应用Cox比例风险回归模型进行多因素生存分析.结果 全组患者平均年龄（74.3±5.4）岁,Ⅰ、Ⅱ、Ⅲ期患者术后5年生存率分别为84.5％、77.3％、48.2％.单因素分析显示：年龄、美国麻醉师协会（ASA）评分、并发症、术前贫血、术前低蛋白血症、术后并发症、术前癌胚抗原（CEA）升高、术中出血量、围术期输血量、脉管癌栓、神经侵犯、肿瘤浸润深度、淋巴结转移、TNM分期及辅助治疗与预后相关.Cox多因素回归分析显示：年龄≥75岁、并发症、术后并发症、术前白蛋白＜30 g/L、肿瘤浸润深度、淋巴结转移、TNM分期及辅助治疗是影响老年结直肠癌患者根治切除术预后的独立因素.结论 老年结直肠癌患者行根治性切除术预后较好,年龄≥75岁、并发症、术后并发症、术前白蛋白＜30 g/L、肿瘤浸润深度、淋巴结转移、TNM分期及辅助化疗是影响其预后的独立因素.

Objective To investigate the risk factors for the prognosis of radical resection in elderly patients with colorectal cancer.Methods A total of 416 patients with colorectal cancer aged over 65 years were analyzed retrospectively,who came from Peking University First Hospital and Beijing Hospital from July 2008 to July 2011.Survival analysis was conducted by Kaplan-Meier and the survival rate was compared by Log-rank method.Multivariate analysis was conducted to analyze the prognostic factors by Cox regression.Results In this group of patients,the age was（74.3 ±5.4）years,and the post operative 5-year survival rate were 84.5%,77.3%,48.2% respectively for staging Ⅰ,Ⅱ,Ⅲ patients.Univariate analysis showed that age,ASA score,co morbidity,preoperative hypohemia,preoperative hypoalbuminemia,postoperative complications,elevated preoperative carcinoembryonic antigen （CEA）,intraoperative blood loss,perioperative blood transfusion,vascular cancer embolus,nerve invasion,depth of invasion,lymph node metastasis,tumor TNM stage and adjuvant therapy were correlated with the prognosis.Multivariate analysis showed that age ≥75 years,co morbidity,postoperative complications,preoperative albumin〈30 g/ L,depth of invasion,and lymph node metastasis,tumor TNM stage and adjuvant therapy were the independent risk factors for prognosis.Conclusions The risk factors for prognosis after radical resection in elderly patients with colorectal cancer include age≥75 years,co-morbidity,postoperative complications,preoperative albumin 〈30 g/L,depth of invasion,and lymph node metastasis,tumor TNM stage and adjuvant therapy.