直肠癌根治术后复发转移的COX回归分析

COX regression analysis of recurrence and metastasis of rectal cancer after radical resection

目的利用COX回归模型分析直肠癌患者根治术后复发转移的影响因素。方法回顾性分析2010年1月至2016年5月本院收治的284例行直肠癌根治术治疗患者的临床资料,记录术后5年复发转移情况,比较不同临床特征患者无瘤生存时间,并使用COX回归模型分析评估直肠癌根治术后5年复发转移的影响因素。结果284例患者在直肠癌根治术后5年共出现复发转移72例(25.35%),无复发转移212例(74.65%)。不同性别、肿瘤直径、分化程度患者无瘤生存时间比较差异无统计学意义;不同年龄、临床分期及淋巴结转移、脉管癌栓、术前血清癌胚抗原(CEA)水平患者无瘤生存时间比较差异有统计学意义(P<0.05)。COX回归模型分析显示,年龄≥60岁、临床分期Ⅲ~Ⅳ、淋巴结转移、脉管癌栓、术前CEA水平>5 ng/ml为影响直肠癌根治术后5年复发转移发生的独立危险因素(P<0.05)。结论直肠癌患者根治术后5年复发转移情况较为严峻,其复发转移与年龄、临床分期、淋巴结转移、脉管癌栓、术前CEA水平等相关,临床应予以相关干预措施,以改善直肠癌患者预后。

Objective To analyze the influencing factors of recurrence and metastasis in patients with rectal cancer after radical resection by COX regression model.Methods The clinical data of 284 patients undergoing radical resection of rectal cancer in our hospital from January 2010 to May 2016 were retrospectively analyzed.The recurrence and metastasis at 5 years after surgery were recorded,and the difference in tumor-free survival time was compared among patients with different clinical characteristics.COX regression analysis was used to evaluate the influencing factors of recurrence and metastasis at 5 years after radical resection of rectal cancer.Results Among 284 patients with rectal cancer at 5 years after radical resection,there were 72 cases(25.35%)with recurrence and metastasis and 212 cases(74.65%)without recurrence and metastasis.There was no statistical difference in the tumor-free survival time among patients with different genders,tumor diameters and degrees of differentiation.There was significant difference in tumor-free survival time among patients with different age groups,clinical stages,lymph node metastasis,vessel carcinoma embolus and preoperative serum carcinoembryonic antigen(CEA)(P<0.05).COX regression model analysis showed that age≥60 years old,clinical stageⅢ-Ⅳ,lymph node metastasis,vessel carcinoma embolus and preoperative CEA level>5 ng/ml were independent risk factors for occurrence of recurrence and metastasis at 5 years after radical resection for rectal cancer(P<0.05).Conclusion The recurrence and metastasis at 5 years after radical resection are severe among patients with rectal cancer.The recurrence and metastasis are related to age,clinical stages,lymph node metastasis,vessel carcinoma embolus and preoperative CEA level.It is necessary to give relevant interventions in clinical practice to improve the prognosis of patients with rectal cancer.