不同原发部位结肠癌根治术后辅助化疗的预后和安全性比较

Comparison of prognosis and safety of adjuvant chemotherapy after radical resection of different primary sites of colon cancer

目的探讨右半结肠癌、降结肠癌及乙状结肠癌不同部位对结肠癌术后辅助化疗的影响,并分析预后相关因素。方法回顾性分析307例结肠癌病例,根据结肠部位的不同分为右半结肠癌组(部位为回盲部至结肠脾曲,n=139)、降结肠癌组(部位为降结肠段,n=32)和乙状结肠癌组(部位为乙状结肠段,n=136)。分析三组术后辅助化疗的差异,并分析影响术后辅助化疗的预后因素。结果307例患者中位无瘤生存时间(disease free survival,DFS)为40.0个月;右半结肠癌组、降结肠癌组和乙状结肠癌组分别有67例(48.2%)、10例(31.6%)和41例(30.1%)在术后3年内出现肿瘤复发或转移,中位DFS分别为36.0个月、45.4个月和47.1个月;三组的复发风险比较,差异具有统计学意义(P=0.001)。经单因素及多因素分析显示,结肠原发部位、肿瘤浸润深度、淋巴结状况、危险度分级及化疗方案是影响3年DFS的独立预后因素(均P<0.05)。按淋巴结状况、危险度分级、病理学分级、化疗方案及化疗疗程进行分层,右半结肠癌组、降结肠癌组和乙状结肠癌组患者的3年DFS比较,差异均具有统计学意义(均P<0.05)。右半结肠癌组、降结肠癌组和乙状结肠癌组患者不良反应发生率比较,差异均无统计学意义(均P>0.05)。结论右半结肠癌、降结肠癌及乙状结肠癌之间DFS存在差异,结肠原发部位、肿瘤浸润深度、淋巴结状况、危险度分级及化疗方案是预后独立相关因素,其中乙状结肠、早期的肿瘤浸润、早期淋巴结转移、高危Ⅱ期和XELOX方案为3年DFS的保护因素。

Objective To investigate the effects of postoperative adjuvant chemotherapy on right colon cancer,descending colon cancer,and sigmoid colon cancer,and analyze the prognostic factors.Methods According to the different parts of the colon,307 colon cancer patients were divided into the right colon cancer group(n=139),descending colon cancer group(n=32),and sigmoid colon cancer group(n=136),retrospectively.The differences in prognosis and safety of postoperative adjuvant chemotherapy were analyzed among the three groups,and the prognostic factors were analyzed.Results The median disease-free survival(DFS)of the 307 colon cancer patients was 40.0 months.In the right colon cancer group,the descending colon cancer group,and the sigmoid colon cancer group,67 patients(48.2%),10 patients(31.6%),and 41 patients(30.1%)had tumor recurrence or metastases within 3 years after surgery,respectively,with mediam DFSs of 36.0,45.4,and 47.1 months.There was a statistically significant difference in the risk of recurrence among the three groups(P=0.001).Univariate and multivariate analysis showed that the primary site of the colon,depth of tumor invasion,lymph node status,risk grading,and chemotherapy regimen were independent prognostic factors for 3-year DFS(all P<0.05).According to lymph node status,risk grading,pathological grading,chemotherapy regimen,and chemotherapy course,the 3-year DFS of patients with right colon cancer,descending colon cancer,and sigmoid cancer was statistically significant(all P<0.05).There was no significant difference in the incidence of adverse reactions between the right colon cancer,descending colon cancer and sigmoid colon cancer patients(all P>0.05).Conclusions There is a statistically significant difference in DFS between right colon cancer,descending colon cancer,and sigmoid colon cancer.In the 3-year DFS-related prognostic factors,the primary site of colon,depth of tumor invasion,lymph node status,risk classification and chemotherapy regimen are independent prognostic factors,and sigmoid colon,early tumor invasion,lymph node metastasis,high-risk phaseⅡ,and Xelox regimen are protective factors for 3-year DFS.