497例原发性结直肠癌患者临床特征分析

Clinical characteristics of 497 patients with primary colorectal cancer

目的了解原发性结直肠癌患者的临床特征,为今后原发性结直肠癌的防治提供参考。方法采用回顾性病例-对照研究方法,收集解放军第306医院2008年1月-2014年7月收治的原发性结直肠癌患者,同时选取非结直肠癌对照者,提取两组人群的临床流行病学特征(年龄、性别、肿瘤部位、肿瘤分化程度、应用药物、既往病史、血脂等),所获资料先进行单因素分析,对初步筛选出的与大肠癌发病相关的因素,再纳入多因素条件Logistic回归模型统计分析。另外,针对肿瘤组病例,分析患者性别、年龄、肿瘤发生部位、分化程度相互之间的关系。结果单因素分析显示,病例组与对照组在服用他汀类降脂药和/或二甲双胍两方面差异具有统计学意义(P<0.05);而在吸烟、饮酒、血脂水平、糖尿病、高血压、冠心病、脑卒中、胆囊结石/切除、阿司匹林、胰岛素等方面差异无统计学意义(P>0.05);多因素分析显示,服用他汀类降脂药及二甲双胍为避免原发性结直肠癌发生的保护因素(P<0.05)。病例组患者仅年龄与肿瘤分化程度之间存在相关性,青年组低分化肿瘤比例高于老年组(P=0.008)。而性别与肿瘤部位及分化程度、年龄与肿瘤部位、肿瘤部位与分化程度之间无相关性(P>0.05)。结论原发性结直肠癌青年患者恶性程度高于老年患者,服用他汀类降脂药和/或二甲双胍可减少原发性结直肠癌发生。

Objective To explore the clinical characteristics of patients with primary colorectal cancer and provide some references for prevention and treatment of this disease in the future. Methods Primary colorectal cancer patients admitted in PLA 306th Hospital from Jan. 2008 to Juh 2014 were collected in the retrospective case-control study. Non- colorectal cancer patients were collected as controls. Both groups＇ clinical characteristics （age, sex, tumor location, tumor differentiation degree, medications, past medical history, serum lipid level） were compared with Chi-square test or nonparametric test firstly, then multi-variables Logistic regression analysis was conducted to those variables which were found closed related with primary colorectal cancer. In addition, the relationship among patients＇ sex, age, tumor location and tumor differentiation degree in case group were analyzed respectively. Results Single-variable analysis showed there was significant difference in using statin and/or metformin between two groups （P 〈 0.05） , but no differ- ence in smoking, alcohol drinking, serum lipid level, diabetes, hypertension, coronary artery disease, stroke, cholecys- tectomy, using Aspirin and insulin between two groups. Multi-variables analysis showed that statin and/or metformin could prevent primary colorectal cancer （P 〈 0.05 ）. In case group, age was related with tumor differentiation degree （ P 〈 0.05 ） , the proportion of poorly differentiated tumor in younger group was higher than that in elder group （ P = 0. 008） , but gender was not related with tumor site and differentiation degree, age was not related with tumor site, tumor site was not related with differentiation degree （P 〉 0.05）. Conclusion The proportion of poorly differentiaed colorectal cancer in young people is higher than old patients. Using statin and/or metformin could prevent primary colorectal cancer.