急诊手术影响结直肠癌患者预后的因素分析

Analysis of prognostic factors of emergency surgery for colorectal cancer patients

目的探讨急诊手术与择期手术的结直肠癌患者预后差异的原因。方法回顾性分析2012年1月至2013年8月于北部战区总医院行根治性手术的379例结直肠癌患者的临床资料。根据手术时机的不同将其分为急诊手术组(n=68)与择期手术组(n=311)。比较两组患者的临床特点及预后,采用Cox比例风险模型对结直肠癌患者预后进行多因素分析。结果与择期手术组比较,急诊手术组病灶好发于结肠(91.2%vs 44.4%,P<0.05),淋巴结转移率较高[(15.4%±2.8%)vs(7.7%±0.8%),P<0.05],血清癌胚抗原(carcinoembryonic antigen,CEA)>5 ng/mL(50.0%vs 21.5%)、肿瘤直径≥5 cm(76.5%vs 39.5%)和脉管浸润(50.0%vs 27.7%)的比例均较高(均P<0.05)。Kaplan-Meier生存曲线显示,急诊手术组的5年总生存率及无瘤生存率均低于择期手术组,差异均具有统计学意义(均P<0.05)。多因素分析发现,血清CEA>5 ng/mL(HR=2.160,95%CI:1.521~3.067,P<0.01)、低分化(HR=1.651,95%CI:1.096~2.486,P=0.016)、T4期(HR=2.395,95%CI:1.642~3.492,P<0.01)和高淋巴结转移率(HR=4.028,95%CI:1.737~9.338,P=0.001)是结直肠癌患者无瘤生存的独立危险因素。结论急诊手术结直肠癌患者远期预后差主要是因为其淋巴结转移率高、血清CEA>5 ng/mL和T4期,而非急诊手术本身。

Objective To investigate the reasons for the difference in prognosis between emergency surgery and elective surgery for colorectal cancer patients.Methods The clinical data of 379 colorectal cancer patients who underwent radical surgery at General Hospital of Northern Theater Command from January 2012 to August 2013 were retrospectively analyzed.According to the different operation timing,the patients were divided into the emergency surgery group(n=68)and elective surgery group(n=311).The clinical characteristics and prognosis of patients in the two groups were compared,and multivariate Cox proportional hazard model was used to analyze the prognosis of colorectal cancer patients.Results Compared with the elective surgery group,the lesions in the emergency surgery group were more likely to occur in colon(91.2%vs 44.4%,P<0.05),and the lymph node metastasis rate was higher[(15.4%±2.8%)vs(7.7%±0.8%),P<0.05].The proportions of patients with serum carcinoembryonic antigen(CEA)level>5 ng/mL(50.0%vs 21.5%),tumor size≥5 cm(76.5%vs 39.5%)and vascular invasion(50.0%vs 27.7%),were all higher(all P<0.05).Kaplan-Meier survival curve showed that the 5-year overall survival and disease-free survival rates of the emergency surgery group were both significantly lower than those of the elective surgery group(both P<0.05).Multivariate analysis showed that serum CEA level>5 ng/mL(HR=2.160,95%CI:1.521-3.067,P<0.01),low differentiation(HR=1.651,95%CI:1.096-2.486,P=0.016),T4 stage(HR=2.395,95%CI:1.642-3.492,P<0.01),and high lymph node ratio(HR=4.028,95%CI:1.737-9.338,P=0.001)were independent risk factors for disease-free survival in colorectal cancer patients.Conclusions The primary reasons for the poor long-term outcomes of colorectal cancer patients who underwent emergency surgery are high lymph node ratio,serum CEA level>5 ng/mL and T4 stage,not emergency surgery.