基于SEER数据库回顾性分析老年结直肠癌伴淋巴结转移患者的预后

A retrospective analysis on prognosis of elderly colorectal cancer patients with lymph node metastasis based on SEER database

目的探讨影响老年结直肠癌伴淋巴结转移患者预后的相关因素。方法利用SEER*Stat软件筛选监测、流行病学和最终结果(Surveillance,Epidemiology,and End Results,SEER)数据库符合要求的老年结直肠癌伴淋巴结转移患者临床资料,提取包括年龄、性别、检出淋巴结数(examined lymph node,ELN)和阳性淋巴结数(positive lymph node,PLN)等关键变量。通过X-tile软件选取检出ELN、PLN以及肿瘤大小的最佳截断值。利用R及SPSS软件进行单因素及多因素Cox比例风险回归模型分析筛选关键变量。结果 1992~2017年老年患者(≥65岁)在结直肠癌患者中占比虽然逐年降低,但均占>50%。X-tile分析显示,ELN最佳截断值为<12枚、12~17枚及>17枚;PLN最佳截断值为<3枚(低风险组)、3~7枚(中风险组)及>7枚(高风险组);肿瘤大小最佳截断值为<35 mm、35~59 mm及>59 mm。单因素及多因素Cox回归分析显示,种族、原发部位、组织学分型、分级、TNM分期、ELN、PLN以及肿瘤大小均为影响预后的相关因素(均P<0.05),C-Index为0.751。根据PLN分层分析显示,低风险组及中风险组中排除组织学分型为预后影响因素,高风险组中排除肿瘤大小为预后影响因素。结论种族、原发部位、组织学分型、分级、TNM分期、ELN、PLN以及肿瘤大小为影响老年结直肠癌伴淋巴结转移患者预后的相关因素。在不同PLN风险组中影响预后的相关因素存在差异。

Objective To investigate the prognostic factors of elderly patients with colorectal cancer with lymph node metastasis. Methods A SEER*Stat software was used to screen the clinical data of elderly patients with colorectal cancer with lymph node metastasis in the Surveillance, Epidemiology, and End R esults(SEER) database. Key variables including age, sex, examined lymph nodes(ELNs) and positive lymph nodes(PLNs) were included. An X-tile software was used to select the optimal cut-off value of the ELN, PLN and tumor size.Using R and SPSS software, univariate and multivariate Cox proportional hazards regression models were used to analyze and screen the key variables. Results From 1992 to 2017, elderly patients(≥65 years) accounted for the majority(>50%) of patients with colorectal cancer,although the proportion was decreased yearly. The optimal cut-off values of ELN in X-tile analysis were <12, 12-17 and >17. The optimal cut-off values of PLN were <3(low-risk group), 3-7(medium-risk group) and >7(high-risk group). The best cut-off values of tumor size were <35 mm, 35-59 mm and >59 mm. Univariate and multivariate Cox regression analysis showed that race, primary site, histological type, grade, TNM stage, ELN, PLN and tumor size were all related factors affecting prognosis(all P<0.05) with a C-index of 0.751. Selected cases were then stratified according to PLN for following analysis, and the results showed that histological types were excluded in the low-risk and medium-risk groups, and tumor size was excluded in the high-risk group as factors affecting prognosis. Conclusions Race,primary site, histological type, grade, TNM stage, ELN, PLN and tumor size are correlative factors for the prognosis of elderly patients with colorectal cancer with lymph node metastasis. The prognostic factors are different among different PLN risk groups.