结直肠癌肝转移患者预后的影响因素研究

Study of the influence factors of the prognosis in patients with liver metastasis from colorectalcancer

目的研究结直肠癌肝转移患者预后的影响因素。方法选取148例结直肠癌肝转移患者作为研究对象，均行手术治疗，并对其进行为期5年的随访调查。分别利用单因素及多因素COX回归分析法初步寻找结直肠癌肝转移患者预后的影响因素；同时绘制受试者工作特征（ROC）曲线评估相关因素对于预测患者手术预后的诊断效能。结果148例患者中，男82例。共有15例患者失访，其余患者按预后情况分为预后良好组102例和预后不良组31例。其中，预后良好组平均年龄（57．82±10．82）岁，男64例；预后不良组平均年龄（55．10±9．52）岁，男18例。Kaplan—Meier曲线结果显示，患者的5年生存率为25．56％，中位生存期为32个月。单因素COX回归分析结果显示肝转移瘤数目、肝转移灶最大直径、存在淋巴转移及血清癌胚抗原（CEA）升高是潜在危险因素；多因素COX回归分析结果进一步表明，肝转移瘤数目、TNM分期、存在淋巴转移及血清CEA水平升高是此类患者预后的影响因素。ROC曲线结果表明，CEA预测患者预后的截断值为43．24U／ml，敏感性为74．00％，特异性为86．70％。结论肝转移瘤数目、TNM分期、存在淋巴转移及血清CEA水平升高是结直肠癌肝转移患者预后的影响因素。

Objective To study the influence factors from the prognosis in patients with liver metastasis from colorectal cancer. Methods A total of 148 patients with liver metastasis from colorectal cancer were enrolled in the study. All patients underwent operation and were followed up for 5 years. Un- ivariate and multivariate COX regression were used to find out the factors associated with prognosis. Fur- thermore, receiver operating characteristic curve （ROC） was used to evaluate the diagnostic value of as- sociated factors in forecasting the outcome of patients with liver metastasis from colorectal cancer. Results Totally, 148 patients were included in the study, of which 82 patients were males. Kaplan-Meiercurve showed that the five-year survival rate was 25.56%, with a median survival of 32 months. Univari- ate COX regression showed that number of metastases, maximum diameter of metastatic tumor, lymph node metastases and elevated carcino-embryonic antigen （CEA） levels were the potential influence fac- tors of prognosis （ all P 〈 0. 05 ）. Multivariate COX regression further showed that number of metastases, stage of lymph node metastases and elevated CEA levels were associated with prognosis （ all P 〈 0.05 ）. ROC result showed that the cut-off value of CEA to predict the prognosis of patients was 43.24 U/ml （ sensitivity ： 74%, specificity ： 86. 70% ）. Conclusions Number of metastases, lymph node metastases stage and elevated CEA levels are associated with the prognosis of patients with liver metastasis from colo- rectal cancer.