晚期结直肠癌化疗后复发转移的影响因素分析

Analysis of the Factors Influencing Recurrence and Metastasis after Chemotherapy for Advanced Colorectal Cancer

目的探讨晚期结直肠癌化疗后复发转移的相关影响因素。方法回顾性分析204例结直肠癌根治术后接受化疗的晚期结直肠癌患者临床资料,依据化疗后2年内是否出现复发转移分为观察组、对照组,对比2组临床资料,分析影响晚期结直肠癌患者化疗后复发转移的因素。结果本研究中共40例于化疗后2年内发生复发转移,发生率为19.61%(40/204),其中局部复发13例次,远处转移33例次。40例复发病例复发中位时间为17个月,其中局部复发中位时间为17.9个月,远处转移发生的中位时间为16.5个月(肝转移与肺转移的中位时间分别为13.5个月和19个月,其他部位转移的中位时间为18.9个月)。单因素及多因素Logistic回归分析发现,长期吸烟饮酒、肿瘤分化程度、术前CEA为晚期结直肠癌患者化疗后复发转移的危险因素,而一线化疗剂量强度、接受热化疗为保护因素(P<0.05)。结论晚期结直肠癌患者化疗后复发转移率高,而长期吸烟饮酒、肿瘤分化程度、术前CEA、一线化疗剂量强度、是否接受热化疗为其影响因素,应加以干预。

Objective To investigate the factors influencing recurrence and metastasis after chemotherapy for advanced colorectal cancer.Methods The clinical data of 204 patients with advanced colorectal cancer were retrospectively analyzed.All patients underwent chemotherapy after radical operation of colorectal cancer.According to presence or absence of recurrence and metastasis within 2 years after chemotherapy,they were divided into the observation group and the control group.The clinical data were compared between the 2 groups.The factors influencing recurrence and metastasis of CRC patients after chemotherapy were analyzed.Results In this study,there were 40 cases with recurrence and metastasis within 2 years after chemotherapy,with incidence of 19.61%(40/204),including 13 cases with local recurrence,33 cases with distant metastasis.Of the 40 recurrence cases,recurrence median time and local recurrence median time were 17 months and 17.9 months,respectively.The median time with distant metastasis was 16.5 months.The median time of liver metastasis and lung metastasis were 13.5 months and 19 months,respectively.The median time of metastases in other parts was 18.9 months.Univariate and multivariate logistic regression analysis found that long-term smoking and drinking,tumor differentiation degree and preoperative CEA were risk factors for recurrence and metastasis in advanced CRC patients after chemotherapy,while dose intensity of first-line chemotherapy and thermochemotherapy were protective factors(P<0.05).Conclusion The rate of recurrence and metastasis is high in advanced CRC patients after chemotherapy.Long-term smoking and drinking,tumor differentiation degree,preoperative CEA,dose intensity of first-line chemotherapy and receiving thermochemotherapy or not are the influencing factors,which should be intervened.