结直肠癌术前不同贫血类型与肿瘤特征、全身炎症和生存的关系

Different types of anemia before colorectal cancer surgery relationship with tumor characteristics,systemic inflammation and survival

目的:探究术前不同贫血类型的结直肠癌患者与肿瘤的特征性参数和全身炎症反应之间的关系,以及术前不同贫血类型的结直肠癌患者的预后情况。方法:回顾性分析航天中心医院普外科2013年01月至2015年12月收治的118例结直肠癌手术患者的临床资料。根据患者的血红蛋白浓度(Hb)、平均红细胞体积(MCV)、平均血红蛋白含量(MCH)、平均血红蛋白浓度(MCHC)情况将患者分为无贫血组、正常细胞贫血组、小细胞性贫血组。比较分析三组患者的一般资料、肿瘤学特征资料和mGPS评分等。术后随访5年,观察生存情况,应用Kaplan-Meier法绘制生存曲线,采用Log-rank检验进行生存分析。应用Cox比例风险回归模型对结直肠癌患者进行影响预后的单因素和多因素分析。结果:本研究中结直肠癌患者术前贫血率为45.8%(54/118)。术前不同贫血类型患者中,在性别、体重减轻程度、CA724、肿瘤部位、肿瘤大小、TNM分期、mGPS评分、Ki-67阳性表达率等方面,差异均具有统计学意义(P<0.05)。无贫血组5年生存率为59.4%,平均生存时间为49个月;小细胞性贫血组5年生存率为29.4%,平均生存时间为34个月;正常细胞性贫血组5年生存率为35.1%,平均生存时间为41个月。无贫血组与小细胞性贫血组和正常细胞性贫血组生存时间比较,差异均具有统计学意义(χ^(2)=5.462,P=0.019;χ^(2)=4.187,P=0.041)。单因素分析结果显示:肿瘤标记物CA199、肿瘤大小、TNM分期、有无远处转移、有无淋巴结转移、mGPS评分、Ki-67阳性表达率、贫血类型等方面是影响结直肠癌患者预后的相关因素(P<0.05)。多因素分析结果显示:肿瘤大小、TNM分期、有无远处转移、mGPS评分、Ki-67阳性表达率、贫血类型等方面是影响结直肠癌患者预后的独立危险因素(P<0.05)。结论:术前不同类型贫血的结直肠癌患者的肿瘤学特征不同,并且全身性炎症可能与术前贫血的状态有关。术前贫血与全身炎症状态是结直肠癌患者预后的独立危险因素。因此,在病人术前准备阶段,应尽可能恢复和改善贫血和全身炎症状态,以获得更好的结直肠癌预后,延长患者的生存时间。

Objective:To explore the relationship between tumor characteristic parameters and systemic inflammatory response of colorectal cancer patients with different anemia types before surgery.As well as the prognosis of colorectal cancer patients with different types of anemia before surgery.Methods:The clinical data of 118 patients with colorectal cancer who were admitted to the general surgery department of aereospace hospital from January 2013 to December 2015 were retrospectively analyzed.According to the hemoglobin(Hb),mean corpusular volume(MCV),mean corpsular hemoglobin(MCH),and mean corpuscular hemoglobin concentration(MCHC),the patients were divided into no-anemia group,microcytic anemia group,and normocytic anemia group.The general data,oncological characteristics and mGPS scores of the three groups were compared and analyzed.The patients were followed up for 5 years after operation and survival was observed.The survival curve was plotted by kaplan-Meier method.Survival analysis was performed using Log-rank test.Univariate and multivariate analyses of prognostic factors were performed in patients with colorectal cancer using Cox proportional hazards regression model.Results:The preoperative anemia rate of colorectal cancer patients in this study was 45.8%(54/118).Among the patients with different anemia types before surgery,there were statistically significant differences in gender,body mass reduction,CA724,tumor site,tumor size,TNM stage,mGPS score and Ki-67 expression rate(P<0.05).The 5-year survival rate of the no-anemia group was 59.4%and the average survival time was 49 months.In microcytic anemia group,the 5-year survival rate was 29.4%and the average survival time was 34 months.The 5-year survival rate of normocytic anemia group was 35.1%and the average survival time was 41 months.The survival time of the no-anemia group was compared with the microcytic anemia group and the normocytic anemia group,and the difference was statistically significant(χ^(2)=5.462,P=0.019,χ^(2)=4.187,P=0.041).Univariate analysis showed that tumor marker CA199,tumor size,TNM stage,presence or absence of distant metastasis,lymph node metastasis,mGPS score,Ki-67 positive expression rate,and anemia type were related factors affecting the prognosis of colorectal cancer patients(P<0.05).Multivariate analysis showed that tumor size,TNM stage,presence or absence of distant metastasis,mGPS score,Ki-67 positive expression rate,and anemia type were independent risk factors affecting the prognosis of colorectal cancer patients(P<0.05).Conclusion:The preoperative colorectal cancer patients with different types of anemia have different oncological characteristics.And systemic inflammation may be related to the state of preoperative anemia.Preoperative anemia and systemic inflammation are independent risk factors for the prognosis of patients with colorectal cancer.Therefore,in the preoperative preparation phase of patients,anemia and systemic inflammation should be restored and improved as much as possible to obtain a better prognosis of colorectal cancer and prolong the survival time of patients.