晚期直肠癌放化疗对预后的影响因素分析

The prognostic risk factors of chemoradiotherapy in advanced patients with rectal cancer

目的探讨放化疗对晚期直肠癌患者预后的影响,并分析影响晚期直肠癌患者预后的危险因素。方法收集218例直肠癌患者的临床资料。截至随访结束,218例直肠癌患者中,删失患者14例,根据随访期间不良预后事件发生情况的不同,将204例患者分为预后不良组(n=107)和预后良好组(n=97)。采用Kaplan-Meier法计算不良预后率,并绘制生存曲线;通过单因素Cox回归分析可能影响直肠癌患者预后的因素,对单因素分析中有统计学意义的指标纳入多因素Cox风险比例回归分析中。结果 Kaplan-Meier生存曲线显示,晚期直肠癌患者发生不良预后事件的平均时间为(45.53±1.30)个月(95%CI:42.99~48.07),中位生存时间为57.00个月(95%CI:42.96~61.04)。晚期直肠癌患者的不良预后率为52.45%,3年累积生存率和5年累积生存率分别为72.08%和55.88%。经单因素Cox比例回归分析结果显示:性别、年龄、血红蛋白、T分期、N分期和CEA水平对晚期直肠癌患者的预后无影响(P﹥0.05),而临床分期、分化程度、肿瘤距肛门距离、手术方式、是否c CR对晚期直肠癌患者的预后有影响(P﹤0.05)。多因素Cox风险比例回归分析结果显示:分化程度、肿瘤距肛门距离、手术方式对晚期直肠癌患者的预后无影响(P﹥0.05),临床分期和是否c CR是影响晚期直肠癌患者预后的独立危险因素(P﹤0.05)。结论放化疗可以在一定程度上改善晚期直肠癌患者的预后,且临床分期、是否c CR是影响晚期直肠癌患者预后的独立危险因素。

Objective To investigate the effect of chemoradiotherapy on the prognosis of patients with advanced rectal cancer and the risk factors for prognosis. Method The clinical data of 218 patients with rectal cancer were collected.Of the 218 cases of rectal cancer, 14 cases were deleted. Patients were divided into poor prognosis group（n=107） and good prognosis group（n=97） depending on the prognosis in the follow-up period. Kaplan-Meier method was used to calculate the poor prognosis rate and draw the survival curve. The single factor Cox regression analysis was used to analyze the factors that may influence the prognosis of rectal cancer patients. In the multivariate Cox risk proportional regression analysis, all the statistically significant factors identified from the single factor analysis were included. Result The Kaplan-Meier survival curve showed that the mean time for adverse prognostic events was（45.53±1.30） months（95% CI：42.99-48.07）, and the median survival time was 57.00 months（95% CI： 42.96-61.04）. The patient＇s poor prognosis rate was 52.45%, and the 3-year and 5-year cumulative survival rates were 72.08% and 55.88%, respectively. The single factor Cox proportional hazards analysis showed that gender, age, hemoglobin, T stage, N stage, CEA level had no statistically significant effect on the prognosis of patients（P〈0.05）, while the clinical staging, differentiation degree, distance from the anus, surgical method and c CR had statistically significant effect on the prognosis of patients（P〈0.05）. According to the result of the multivariate Cox risk proportional regression analysis, differentiation degree, distance from the anus and surgical method had no independent significant effect on the prognosis of patients（P〈0.05）, while the clinical staging and c CR were independent prognostic factors（P〈0.05）. Conclusion To a certain extent, the prognosis of patients with advanced rectal cancer can be improved by chemoradiotherapy. Clinical staging and c CR are independent predictors of prognosis of rectal cancer patients.