老年结直肠癌病人化疗耐受性的影响因素分析

Analysis of influencing factors of chemotherapy tolerance in elderly patients with colorectal cancer

目的探讨影响老年结直肠癌病人化疗耐受性的影响因素,以期为筛选适合化疗的老年肿瘤病人提供一定的依据。方法回顾性分析我院2017~2021年间154例被诊断为结直肠癌且接受化疗的老年病人(年龄≥65岁),以其化疗结果分为化疗耐受良好、化疗基本耐受、化疗不耐受3组,比较3组病人的基础情况、肿瘤情况、营养状况、情感状况、治疗情况等,并以化疗耐受良好为一组,剩余病人为另一组,采用Logistic回归分析影响老年结直肠癌病人化疗耐受性的独立危险因素。结果154例病人中,108例病人化疗耐受良好,27例病人化疗基本耐受,19例病人化疗不耐受。单因素分析提示:各组间年龄、基础疾病数量、肿瘤部位、临床分期、治疗方式、体力状况(PS)评分、营养状况、抑郁状态以及化疗前PLT、Hb、前白蛋白、白蛋白、癌胚抗原(CEA)水平差异有统计学意义。Logistic回归分析显示,肿瘤部位、临床分期、治疗方式、PS评分、营养状况、抑郁状态、Hb、白蛋白、CEA为化疗耐受差的独立影响因素。结论老年结直肠癌病人也应得到积极抗癌治疗,化疗作为主要的抗癌治疗手段,不应以年龄作为简单的判断,Hb、白蛋白、CEA作为化疗耐受性差的独立影响因素可作为有效的参考指标。同时,肿瘤部位、临床分期、治疗方式、PS评分、营养状况、是否抑郁作为独立影响因素也需考虑在内。

Objective To explore the influencing factors of chemotherapy tolerance in the elderly patients with colorectal cancer,in order to provide basis for screening elderly patients suitable for chemotherapy.Methods A retrospective study was conducted among 154 elderly patients(aged≥65 years)who were diagnosed as colorectal cancer and received chemotherapy from 2017 to 2021,and the patients were divided into good chemotherapy tolerance group,basic chemotherapy tolerance group,and chemotherapy intolerance group according to the chemotherapy outcomes.The basic conditions,tumor conditions,nutritional status,emotional conditions and treatment conditions were compared in the three groups.Multivariate regression analysis was further performed to analyze the independent risk factors of chemotherapy tolerance in the elderly patients with colorectal cancer.Results Among 154 patients,108 presented with good chemotherapy tolerance,27 with basic chemotherapy tolerance(70.2%)and 19 with chemotherapy intolerance.Single factor analysis showed that age,number of basic diseases,tumor site,clinical stage,treatment mode,Performance Status(PS)Score,nutritional status,depression,and the levels of platelet,hemoglobin(Hb),prealbumin,albumin and carcinoembryonic antigen(CEA)were significantly different among the groups.Logistic regression analysis showed that tumor site,clinical stage,treatment mode,PS score,nutritional status,depression,Hb,albumin,and CEA were the independent influcencing factors for poor chemotherapy tolerance.Conclusions Elderly patients with colorectal cancer should receive active anti-cancer treatment.Chemotherapy as the main anti-cancer treatment should not be judged simply by age.Hb,albumin and CEA can be used as predictive indicators for prognosis.At the same time,tumor site,clinical stage,treatment mode,PS score,nutritional status and depression should also be considered as the independent influencing factors.