老年结肠癌患者根治术后辅助化疗疗效及影响预后的多因素分析

Effect of adjuvant chemotherapy after radical resection on colon cancer prognosis and its relative factors analysis in elderly patients

目的探讨Ⅱ、Ⅲ期老年结肠癌患者术后辅助化疗疗效及影响预后因素。方法回顾性收集行结肠癌根治术、术后分期为Ⅱ或Ⅲ期的老年患者（〉60岁）临床病理资料及术后治疗资料，采用Kaplan--Meier法比较术后辅助化疗老年患者和单纯手术老年患者无复发生存（DFS）和总生存（0S），并按临床分期进行亚组分析。用COX回归模型对可能影响预后的多种因素进行分析。结果全组患者317例，其中113例患者仅接受手术治疗，204例患者术后接受氟尿嘧啶类单药或联合奥沙利铂术后辅助化疗。两组患者DFS和OS差异无统计学意义（69．0％比69．6％，P=0．966；69．9％比76．0％，P=0．250）。亚组分析显示Ⅱ期老年患者两组DFS和oS差异无统计学意义（82．3％比82．1％，P=0．959；83．5％比88．4％，P=0．306），而Ⅲ期老年患者两组DFS和OS均差异有统计学意义（38．2％比58．7％，P=0．02；38．2％比65．1％，P=0．003）。多因素分析显示，T4、N分期阳性、合并脉管瘤栓、术后未予化疗、术前CA19—9升高是影响老年患者生存的独立因素。结论Ⅱ期老年结肠癌术后辅助化疗不改善DFS和OS，Ⅲ期老年患者术后给予辅助化疗能延长DFS和OS。TNM分期、脉管瘤栓、术前CA19—9水平、术后治疗模式是影响老年患者生存的独立因素。

Objective To explore the effect of adjuvant chemotherapy on colon cancer prognosis and its prognostic factors in elderly patients with stageⅡ / Ⅲ colon cancer after radical resection. Methods The clinical and pathological as well as postoperative therapy data were collected and analyzed in elderly patients （aged〉 60 years） with stage Ⅱ / Ⅲ colon eancer undergoing radical resection. The disease-free survival （DFS） and overall survival （OS） rate was compared between the surgery alone group and the postoperative adjuvant chemotherapy group by Kaplan-Meier analysis, and patients were sub-grouped based on clinical stage. The analysis of prognostic factors was conducted by Cox regression. Results Among 317 patients, 113 patients received surgery alone and 204 patients received postoperative adjuvant ehemotherapy （fluorouraeil alone or combined with oxaliplatin）. There were no significant differences in DFS and OS between the two groups （69.0% vs. 69.6%, 69.9% vs. 76.0%, P=0. 966 and 0. 250）. No difference in DFS and OS in patients with stage Ⅱ colon cancer was observed between the two groups （82.3% vs. 82.1%, 83.5% vs. 88.4G, P= 0. 959 and 0. 306）. However, postoperative adjuvant chemotherapy improved DFS and OS in patients with stage Ⅲ colon cancer （38.2% vs. 58.7%0, 38.2% vs. 65.1%, P=0. 02 and 0. 003）. Multivariate analysis showed that the independent predictors for prognosis were T4, N ＋, combination with vascular invasion, surgery alone, preoperative CA19 9 level. Conclusions Postoperative adjuvant chemotherapy cannot improve the DFS and OS in elderly patients with stage Ⅲ colon cancer, but can improve the overall survival rate in those with stageⅢ. TNM staging, vascularinvasion, preoperative CA19-9 level and the therapeutic model after surgery are the independent factors influencing the prognosis in elderly patients with colon cancer.