老年直肠癌术后辅助化疗相关病理特征及预后多因素分析

Postoperative adjuvant chemotherapy related pathological characteristics of elderly rectal cancer and multivariate analysis of prognosis

目的探讨老年直肠癌术后辅助化疗相关病理特征及预后多因素分析。方法回顾性分析2007年1月至2010年1月收治的200例老年直肠癌患者临床资料,包括姓名、年龄、性别、主诉症状、症状出现及持续时间、术前癌胚抗原(CEA)、手术日期、手术方式、TNM分期、病理分化程度、肿瘤部位、大小、淋巴结转移情况、肿瘤浸润情况、淋巴结检出数目、放化疗方案及时间、术后复发及转移情况等一般资料。采用Kaplan-Meier法计算生存率,Long-Rank法对影响其预后的相关因素进行单因素分析,同时将经单因素分析为预后危险因素纳入多因素Cox回归模型分析。结果本组200例患者,术后3、5年总生存率分别为80.63%和73.75%。肿瘤直径>5 cm、肿瘤低分化、浸润深度、TNM分期Ⅲ期、淋巴结转移、术前CEA>10 ng/m L及术后是否行辅助化疗是影响患者预后的危险因素。将以上7项指标进行多因素Cox回归分析发现,肿瘤直径>5 cm、肿瘤低分化、TNM分期Ⅲ期、淋巴结转移、术前CEA>10 ng/m L是影响患者预后的独立危险因素(P<0.05)。结论肿瘤直径>5 cm、肿瘤低分化、TNM分期Ⅲ期、淋巴结转移及术前CEA>10 ng/m L是影响患者预后的独立危险因素,而对于存在淋巴结转移及术前CEA>10 ng/m L的高危患者可考虑术后辅助化疗。

Objective To investigate the pathological characteristics related to postoperative adjuvant chemotherapy of elderly rectal cancer and analyze the prognostic factors. Methods Clinical data of 200 elderly patients with rectal cancer treated in our hospital during Jan. 2007 and Jan. 2010 were retrospectively review ed. Patient＇s age,gender,complaints,duration of symptoms,preoperative（ carcino-embryonic antigen CEA）,date of surgery,surgical procedure,TNMstage,pathological differentiation,tumor location,size,lymph node metastasis,tumor invasion,number of examined lymph nodes,rehabilitation plan and time,postoperative recurrence and metastasis were analyzed. KaplanMeier method was employed to calculate the survival rate,Long-Rank test was adopted to analyze single prognostic factor,and Cox regression analysis was performed to assess the multi- factors. Results The postoperative 3-year and5-year survival rates were 80. 63% and 73. 75%. Tumor diameter〉 5 cm,poor tumor differentiation,TNMstage Ⅲ,lymph node metastasis,and preoperative CEA 〉10 ng/m L were the independent risk factors of prognosis. Conclusion Tumor diameter 〉5 cm,low tumor differentiation,TNMstage Ⅲ,lymph node metastasis,and preoperative CEA 〉10 ng/m L are the independent risk factors affecting the prognosis,and patients with lymph node metastasis and preoperative CEA 〉10 ng/m L had better receive adjuvant chemotherapy after operation.