年龄对Ⅳ期直肠癌患者预后及远处转移的影响分析

The effect of age on prognosis and distant metastasis in patients with stage Ⅳ rectal cancer

目的 探讨Ⅳ期直肠癌患者年龄与转移及预后的关系。方法 将SEER数据库中纳入的4 269例Ⅳ期直肠癌患者按照年龄分为年轻组(<50岁),中老年组(≥50岁)。采用Kaplan-Meier法绘制生存曲线。通过Cox回归分析影响患者预后的因素。采用Logistic回归分析年龄对IV直肠癌患者转移部位的影响。结果 与年轻组相比,中老年组更易出现肝转移[OR=1.30,95%CI(1.05,1.61),P=0.016],但发生肺转移的风险更低[OR=0.81,95%CI(0.68,0.95),P=0.011]。而其他转移部位(骨、脑、多部位),两组间的差异无统计学意义。生存分析提示,年轻组生存率优于中老年组(P<0.001),中位生存时间分别为28个月、18个月。且当患者发生仅肝转移、仅肺转移及多部位转移时,年轻组预后仍较中老年组好(P <0.05)。多因素分析表明年龄是影响Ⅳ直肠癌患者的独立预后因素,种族、T分期、N分期、化疗、放疗以及手术也是Ⅳ期直肠癌患者的独立预后因素。结论 年龄是影响Ⅳ直肠癌患者转移部位及预后的重要因素。

Objective To investigate the effect of age on distant metastasis and prognosis in patients with stage Ⅳ rectal cancer. Methods The 4 269 patients with stage Ⅳ rectal cancer from SEER database were divided into younger group(<50 years old) and elderly group(≥50 years old). Kaplan-Meier method was used to generate survival curves. Cox regression was applied to predict prognostic factors for OS. Furthermore, logistic regression was performed to analyze the effect of age on metastasis site in patients with stage Ⅳ rectal cancer.Results Compared with the younger group, the elderly group was more likely to appear liver metastasis(P=0.016), but had fewer lung metastasis(P=0.011). And there was no significant difference in other metastatic sites(bone, brain, and multiple sites) among two age groups.Survival analysis showed that younger patients had better survival rate than the elderly group(P<0.001) with the median survival time being 28 months and 18 months, respectively. Among patients with liver metastasis only, lung metastasis only and multiple sites metastases, younger group showed better survival than elderly group(all P<0.05). Multivariate analysis revealed that age was an important independent prognostic factor for patients with Ⅳ rectal cancer, and race,T-stage, N-stage, chemotherapy, radiation and surgery are also independent prognostic factors.Conclusion Age was an important factor affecting the metastasis site and prognosis of patients withⅣ rectal cancer.