结直肠癌患者年龄对长期生存预后可能有影响:基于DACCA数据库的真实世界分析

The age of colorectal patients may impact on long-term survival:a real-world study based on DACCA database

目的分析目前版本的华西肠癌数据库(Database from Colorectal Cancer,DACCA)中,华西医院作为区域性中心所服务的结直肠癌患者人群的年龄与预后的关系。方法本次数据分析选取的DACCA版本为2022年1月5日更新版,其中分析的数据项目包括年龄、性别、肿瘤部位、肿瘤病理学性质、梗阻、病理TNM(pTNM)分期、阳性淋巴比、生存状态和生存时间。根据我国年龄分段标准将年龄划分为年轻组(<35岁)、中年组(35~59岁)和老年组(>59岁)。对3个年龄组的总体生存(overall survival,OS)和疾病特异性生存(disease specific survival,DSS)情况进行分析,再按pTNM分期比较各年龄组的OS和DSS情况。结果按照筛选条件从DACCA数据库中获得数据3625条。不同年龄组的生存情况分析结果显示:中年组相较于老年组其1年(97.4%比96.0%,P=0.037)、3年(90.9%比88.0%,P=0.030)和5年(81.7%比75.7%,P=0.002)OS更好以及5年DSS更好(82.2%比77.7%,P=0.020);年轻组与老年组之间的生存情况差异无统计学意义(P>0.05)。各pTNM期不同年龄组的生存情况分析结果显示:(1)中年组的中长期OS比老年组更好。pTNMⅠ期中,中年组3年和5年OS优于老年组(100%比93.4%,P=0.004;100%比91.4%,P=0.005);pTNMⅡ期中,中年组的5年和10年OS优于老年组(96.5%比91.3%,P=0.018;88.2%比54.3%,P<0.001);pTNMⅢ期中,中年组10年OS优于老年组(36.5%比36.0%,P<0.001);pTNMⅣ分期中,中年组的5年和10年OS优于老年组(67.7%比58.4%,P=0.016;19.1%比7.2%,P=0.049)。(2)中年组的中长期DSS比老年组更好。pTNMⅠ期中,中年组的3年和5年DSS优于老年组(100%比96.9%,P=0.047;100%比94.9%,P=0.049);pTNMⅡ期中,中年组的10年DSS优于老年组(88.2%比61.9%,P=0.002);pTNMⅣ期中,中年组的5年和10年DSS优于老年组(68.3%比59.1%,P=0.020;20.9%比7.7%,P=0.040)。(3)除pTNMⅠ期外,其余各pTNM分期年轻组与老年组之间的生存情况差异均无统计学意义(P>0.05);pTNMⅠ期中,年轻组的3年和5年OS优于老年组(100%比93.4%,P=0.004;100%比91.4%,P=0.005);年轻组的3年和5年DSS优于老年组(100%比96.9%,P=0.047;100%比94.9%,P=0.049)。结论结直肠癌患者的年龄对长期生存预后可能有影响,中年患者相较于老年患者有更优的预后,年轻组患者仅在pTNM I期预后优于老年患者。

Objective To analyze the relationship between age and prognosis of colorectal patients in the database from colorectal cancer(DACCA).Methods The DACCA version selected for this data analysis was updated on January 5,2022.The data items analyzed included age,sex,tumor site,tumor pathological nature,obstruction,pathological TNM(pTNM)stage,positive lymph node ratio,survival status and survival time.According to China’s age segmentation standard,the included data were grouped into younger group(<35 years old),middle-aged group(35–59 years old)and elderly group(>59 years old).Overall survival(OS)and disease specific survival(DFS)were analyzed in three age group,and OS and DSS in three age group were analyzed in pTNM stage stratification.Results Three thousand six hundred and twenty-five rows of data were obtained from DACCA database according to the screening conditions.The survival analysis results of different age groups show that:The middle-aged group had better OS compared with the elderly group at 1-year(97.4%vs.96.0%,P=0.037),3-year(90.9%vs.88.0%,P=0.030)and 5-year(81.7%vs.75.7%,P=0.002).Also,the middle-age group had better 5-year DSS(82.2%vs.77.7%,P=0.020).There was no statistical difference in survival between the younger group and the elderly group(P>0.05).The survival analysis results of different age groups in each pTNM stage show that:(1)The middle-aged group had better medium-term and long-term OS than the elderly group.In the pTNMⅠstage,the 3-and 5-year OS in the middle-aged group were better than those in the elderly group(100%vs.93.4%,P=0.004;100%vs.91.4%,P=0.005).In the pTNMⅡstage,the 5-and 10-year OS in the middle-aged group were better than those in the elderly group(96.5%vs.91.3%,P=0.018;88.2%vs.54.3%,P<0.001).In pTNMⅢstage,10-year OS in the middle-aged group was better than that in the elderly group(36.5%vs.36.0%,P<0.001).In pTNMⅣstage,the 5-and 10-year of OS in the middle-aged group were better than those in the elderly group(67.7%vs.58.4%,P=0.016;19.1%vs.7.2%,P=0.049).(2)The middle-aged group had better medium-term and long-term DSS than the elderly group.In the pTNMⅠstage,the 3-and 5-year DSS in the middle-aged group wrer better compared to the elderly group(100%vs.96.9%,P=0.047;100%vs.94.9%,P=0.049).In the pTNMⅡstage,the 10-year DSS in the middleaged group outperformed that in the elderly group(88.2%vs.61.9%,P=0.002).In the pTNMⅣstage,the 5-and 10-year DSS in the middle-aged group were better than the elderly group(68.3%vs.59.1%,P=0.020;20.9%vs.7.7%,P=0.040).(3)Except pTNM I stage,there was no significant difference in survival of other pTNM stages between young group and old group(P>0.05).In the pTNMⅠstage,3-and 5-year OS were better in the younger group compared with the elderly group(100%vs.93.4%,P=0.004;100%vs.91.4%,P=0.005),and better 3-and 5-year DSS in the younger group(100%vs.96.9%,P=0.047;100%vs.94.9%,P=0.049).Conclusions The age of colorectal cancer patients may have an impact on long-term survival.Middle-aged patients have better prognosis compared with elderly patients,and the younger group patients have better prognosis in pTNM stageⅠonly.