Ⅲ期结直肠癌患者预后因素分析以及探讨淋巴结转移率对预后的预测价值

Prognostic factors of stageⅢcolorectal cancer patients and the prognostic value of lymph node metastasis rate

目的探讨Ⅲ期结直肠癌患者预后因素以及淋巴结转移率对预后的预测价值。方法回顾性分析2011年1月至2015年12月到汉川市人民医院接受根治性手术治疗的201例Ⅲ期结直肠癌患者的临床资料,分析其临床病理特征及与生存预后的关系。根据四分位法将患者按LNR值分为4组,比较各组患者的生存率,用Kaplan-Meier法进行生存分析,并进行单因素分析和COX多因素生存分析。结果对所有患者进行随访,随访时间为从患者出院至死亡或超过60个月生存时间,12-68个月为随访期,平均(50.32±13.86)个月,中位数51个月。所有患者5年DFS和OS分别为44.8%、53.2%。不同LNRⅢ期结直肠癌患者的生存曲线比较差异均有统计学意义,LNR值越高,患者5年DFS和OS越低(P<0.05)。单因素分析结果显示,T分期、N分期、LNR、肿瘤分化程度、淋巴结数目与Ⅲ期结直肠癌患者的DFS、OS有关(P<0.05)。COX多因素生存分析(Enter法)结果显示,肿瘤分化程度、T分期、N分期、LNR是影响Ⅲ期结直肠癌患者预后的独立因素(P<0.05)。结论肿瘤分化程度、T分期、N分期、LNR是影响Ⅲ期结直肠癌患者预后的重要因素,可以作为临床评估预后的指标。

Objective To investigate the prognostic factors of stageⅢcolorectal cancer patients and the prognostic value of lymph node metastasis rate.Methods The clinical data of 201patients with stageⅢcolorectal cancer who received radical surgery in our hospital from January 2011to December 2015were retrospectively analyzed,its clinicopathological characteristics and its relationship with survival and prognosis was analyzed.The patients were divided into 4groups according to LNR value according to quartile method,the survival rate of each group was compared,and the survival analysis was carried out by Kaplan-Meier method.And carry on single factor analysis and COX multi-factor survival analysis.Results All patients were followed up from discharge to death or survival for more than 60months.The follow-up period was 12-68months,average(50.32±13.86)months,median 51months.The five-year DFS and OS of all patients were 44.8%and 53.2%.The survival curve of colorectal cancer patients in different LNRⅢstages was statistically significant.The higher the LNR value,the lower the DFS and OS of 5years(P<0.05).Univariate analysis showed that tumor differentiation,T stage,N stage,lymph node number,LNR were associated with DFS,OS in stageⅢcolorectal cancer patients(P<0.05).COX multivariate survival analysis(Enter method)showed that tumor differentiation,T stage,N stage,and LNR were independent factors affecting the prognosis of stageⅢcolorectal cancer patients(P<0.05).Conclusion Tumor differentiation,T stage,N stage,and LNR are important factors affecting the prognosis of patients with stageⅢcolorectal cancer,which can be used as indicators for clinical evaluation of prognosis.