影响Ⅲ期结直肠癌预后的相关因素分析

Prognostic Factors of Stage Ⅲ Colorectal Cancer in 433 Patients

目的总结Ⅲ期结直肠癌病例的临床病理特点、术后治疗特点及生存规律。方法回顾性分析了2005年1月至2008年12月在中国人民解放军总医院接受根治性手术治疗及术后辅助化疗的433例Ⅲ期结直肠癌患者的临床资料,总结了其临床病理特征、治疗特点及与生存预后的关系。结果 433例Ⅲ期结直肠癌患者的平均无疾病生存时间为(72.37±2.11)个月,中位无疾病生存时间未达到,1、3、5年无疾病生存率分别为86.8%、77.9%、57.0%。平均总生存时间为(79.91±2.02)个月,中位总生存时间未达到,1、3、5年总生存率分别为91.5%、75.1%、63.3%。COX多因素生存分析结果显示,术前肠梗阻、术后并发症、肿瘤部位、切缘阳性、神经浸润、脉管癌栓、肿瘤淋巴结转移(TNM)分期、淋巴结转移比率、辅助化疗方案、化疗持续时间等因素均为影响无疾病生存和总生存的独立预后因素。FOLFOX和XELOX方案与患者年龄、是否术后并发症、肿瘤部位及化疗持续时间具有明显相关性。结论术后并发症、肿瘤部位、TNM分期、切缘阳性等临床病理因素是Ⅲ期结直肠癌的独立预后因素。FOLFOX和XELOX方案可显著改善患者预后,化疗维持时间较长者治疗效果好。

Objective To summarize the prognostic factors of stage Ⅲ colorectal cancer. Methods The clinical data of 433 patients with stage Ⅲ colorectal cancer who were admitted to our hospital from January2005 to December 2008 for radical surgery and adjuvant chemotherapy were retrospectively analyzed. Relationship of their clinicopathologic features and treatment with the prognosis were analyzed. Results Of these 433 stage Ⅲpatients,the mean disease-free survival was（ 72. 37 ± 2. 11） months and mean overall survival was（ 79. 91 ±2. 02） months; however,the median survival times were not reached. The 1-,3-,and 5-year disease-free survival rate were 86. 8%,77. 9%,and 57. 0% and the overall survival rate were 91. 5%,75. 1%,and 63. 3%.Multivariate COX regression analysis displayed that intestine obstruction before surgery,complications after surgery,tumor location,positive surgical margin, neural cell infiltration, vessel cancer embolus, TNM stage,lymph node ratio,adjuvant chemotherapy regimens,and chemotherapy duration were the independent factors affecting disease-free and overall survivals in patients with stage Ⅲ colorectal cancer. The efficacies of FOLFOX and XELOX regimens were significantly correlated with patient ＇s age, complications, tumor location, and chemotherapy duration. Conclusions Complications,tumor location,TNM stage,and positive surgical marginare the independent prognostic factors of stage Ⅲ colorectal cancer. FOLFOX and XELOX regimen can remarkably improve prognosis,and a longer duration of chemotherapy can achieve better survival.