无淋巴结转移直肠癌病人预后影响因素分析

RECTAL CANCER WITH NO LYMPH-NODE METASTASIS:ANALYSIS OF FACTORS INFLUENCING PATIENT'S PROGNOSIS

目的探讨影响无淋巴结转移直肠癌病人预后的相关因素。方法选择2008年7月—2014年7月在我科接受根治切除手术,且经术后病理证实为无淋巴结转移的直肠癌病人161例。病人均进行随访,采用Kaplan-Meier法计算生存率。直肠癌预后单因素分析采用Log-rank法,将单因素分析有意义的因素引入COX比例风险回归模型进行多因素分析。结果病人1、3、5年生存率分别为88%、74%、55%。单因素分析显示,病人术前血清癌胚抗原（CEA）水平、肿瘤长径、肿瘤T分期和肿瘤分化程度是直肠癌病人预后的影响因素（χ2=6.439~25.016,P〈0.05）;病人年龄、术后是否接受辅助放化疗与预后无关。多因素分析显示,术前血清CEA水平（RR=4.208,95%CI=2.168~8.165,P〈0.05）、肿瘤分化程度（RR=0.385,95%CI=0.200~0.744,P〈0.05）以及肿瘤T分期（RR=4.896,95%CI=2.440~9.827,P〈0.05）是直肠癌预后的独立影响因素。结论术前血清CEA水平、肿瘤分化程度和肿瘤T分期是无淋巴结转移直肠癌病人预后的独立影响因素。

Objective To investigate prognosis related factors in rectal cancer patients with no lymph-node metastasis. Methods From July, 2008 to July, 2014,161 patients underwent radical surgery for rectal cancer--with postoperative pathology of no lymph node metastasis--were selected in this study. A follow-up was done in all the patients. The survival rate was calculated using Kaplan-Meier method. Single factor analysis for the prognosis was done using Log-rank method, and the significant factors were then inducted into COX regression analyses. Results The 1-, 3-, and 5-year survival rates were 88%, 74% and 55 %, re- spectively. Monofactorial analysis indicated that： preoperative CEA level, diameter of tumor, the degree of differentiation and T staging were significant factors influencing the prognosis （x2 = 6.439 -- 25.016, P〈0.05）. Patient age and whether or not wit h post- operative adjuvant chemotherapy were uncorrelated with the prognosis. Multivariate analysis showed that preoperative CEA level （RR=4.208,95%CI=2.168--8.165,P〈0.05）,degree of cell differentiation of the tumor （RR=0.385,95%CI=0.200--0.744, P〈0.05） and T staging （RR- 4.896,95% CI = 2.440--9.827,P〈0.05） were the independent factors influencing the prognosis. Conclusion Preoperative CEA level, degree of cell differentiation of tumor and T staging are independent factors that impact the prognosis of rectal cancer patients without lymph node metastasis.