结肠癌根治术后FOLFOX或XELOX化疗的Ⅱ、Ⅲ期老年患者无复发生存期和总生存期及其影响因素分析

Analysis of disease-free survival rate and overall survival time and the influencing factors in elderly patients with stage Ⅱ and Ⅲ performed FOLFOX or XELOX chemotherapy after radical resection of colon cancer

目的分析结肠癌根治术后奥沙利铂+氟尿嘧啶/亚叶酸钙(FOLFOX4)或奥沙利铂+卡培他滨(XELOX)化疗的Ⅱ、Ⅲ期老年患者无复发生存率和总生存率及其影响因素。方法回顾性分析2010年1月至2014年12月305例行结肠癌根治术治疗的Ⅱ、Ⅲ期老年(年龄超过60岁)患者的临床资料,其中104例患者单纯接受手术治疗为A组,201例患者术后给予FOLFOX或XELOX进行辅助化疗为B组。通过统计学分析并比较两组患者无复发生存率和总生存率的差异,并通过多因素分析影响患者预后效果的相关因素。结果两组患者无复发生存率和总生存率的比较,均无显著差异(P>0.05)。Ⅱ期患者中,A、B组无复发生存率和总生存率的比较,均无显著差异(均P>0.05);但Ⅲ期患者中,B组无复发生存率和总生存率较A组均显著升高(均P<0.05)。Cox回归模型分析结果发现,伴有脉管瘤栓、TNM分期、术前癌抗原(CA)19-9水平升高及术后未接受化疗是老年患者预后不良的主要影响因素(P>0.05)。结论结肠癌根治术后接受辅助化疗对Ⅱ期老年患者预后效果的改善作用并不明显,但可明显延长Ⅲ期老年患者的生存时间,伴有脉管瘤栓、TNM分期、术前CA19-9水平升高及术后未巩固治疗均会影响老年患者术后生存状况。

Objective To analyze the disease-free survival rate and overall survival rate and the influencing factors in elderly patients with stage II and III performed FOLFOX4(oxaliplatin+fluorouracil/calcium folate)or XELOX(oxaliplatin+capecitabine)after radical resection of colon cancer.Methods 305 elderly patients(aged over 60 years)with stage II and III undergoing radical resection of colon cancer from January 2010 to December 2014 were analyzed retrospectively,including 104 patients only underwent surgical treatment as group A,201 patients treated with FOLFOX or XELOX for adjuvant chemotherapy after surgery as group B.The disease-free survival rate and overall survival rate were statistically analyzed and compared between the two groups,and the influencing factors on prognosis were analyzed by multivariate analysis.Results There was no significant difference in disease-free survival rate and overall survival rate between the two groups(P>0.05).Among of patients with stage II,there was no significant difference in disease-free survival rate and overall survival rate between group A and group B(P>0.05),but in the stage III,the disease-free survival rate and overall survival rate in group B were significantly higher than those in group A(P<0.05).Cox regression model analysis showed that vascular invasion,TNM staging,preoperative CA19-9 level increased and without postoperative chemotherapy were the main influencing factors of poor prognosis in elderly patients(P>0.05).Conclusion Postoperative adjuvant chemotherapy after radical resection of colon cancer can't significantly improve the effects on the prognosis of eldery patients with stage II,but can significantly prolong the survival time of patients with stage III,and the vascular invasion,TNM staging,preoperative CA19-9 level increased and without postoperative treatment can affect the survival conditions of patients.