高龄与Ⅱ期结直肠癌患者预后不良的相关性研究

Correlation study between advanced age and inferior prognosis in stage Ⅱ colorectal cancer patients

背景与目的:随着人口老龄化,老年结直肠癌(colorectal cancer,CRC)患者日益增加。目前高龄Ⅱ期CRC患者在接受根治术后通常接受减弱的化疗方案或不化疗,而这是否会引起不良的肿瘤学结局目前仍不明确。本研究旨在通过多因素COX回归分析方法探究去除偏倚后,高龄对于Ⅱ期CRC患者预后的影响。方法:回顾性收集3 314例2008—2019年在复旦大学附属肿瘤医院接受过手术治疗且术后病理学检查结果为Ⅱ期、无既往肿瘤史、术后5年内无第二原发肿瘤且术前未接受新辅助治疗的CRC患者。本研究通过复旦大学附属肿瘤医院医学伦理委员会的审查(伦理编号:050432-4-2108^(*))。使用R软件(version 3.0)的survminer包(surv_cutpoint算法)计算年龄相对于生存的最佳临界值为73岁。比较高龄组(年龄>73岁)和非高龄组(年龄≤73岁)的临床病理学特征、总生存期(overall survival,OS)和无病生存期(disease-free survival,DFS),并使用survival包和rms包绘制列线图预测模型。结果:高龄组和非高龄组在性别、肿瘤位置、分化、脉管侵犯、神经侵犯和pT分期等方面均衡可比。多因素COX回归分析显示,高龄是OS[风险比(hazard ratio,HR)=3.667(2.946~4.565),P <0.001]和DFS[HR=2.368(1.953~2.872),P<0.001]的独立预后危险因素。根据多因素COX回归分析构建的列线图预测模型可以有效地评估Ⅱ期CRC患者的预后。结论:在Ⅱ期CRC患者中,高龄与较短的OS及DFS相关。足够强度的辅助化疗或许是必要的。治疗决策可根据患者列线图预测模型得分进行调整。

Background and purpose:With the aging population,the number of elderly patients with colorectal cancer(CRC is increasing.To date,elderly patients with stage Ⅱ CRC often receive a weakened chemotherapy regimen or even no chemotherapy after radical surgery,and It is still unclear whether this will lead to adverse oncological outcomes.This study aimed to explore the prognostic impact of advanced age on stage Ⅱ CRC patients after removing bias through a multivariate COX regression approach.Methods:We retrospectively collected data of 3314 colorectal cancer patients with postoperative pathology of stage Ⅱ,no history of previous tumors,no secondary primary tumors within 5 years after surgery and no preoperative neoadjuvant therapy.This study was reviewed by the medical ethics committee of Fudan University Shanghai Cancer Center(ethics number:050432-4-2108^(*)).The optimal threshold for calculating age relative to survival using survminer package of R software(version 3.0)(surv_cutpoint algorithm) was 73 years.We compared the clinical and pathological characteristics,overall survival(OS) and disease-free survival(DFS) between the older group(age>73 years) and the younger group(age≤73 years).The alignment diagram prediction model was drawn using the survival package and RMS package.Results:The elderly and non-elderly groups were evenly comparable in terms of gender,tumor location,differentiation,vascular invasion,perineural invasion and pT stage.Multivariate COX regression showed that advanced age was an independent prognostic risk factor for OS [hazard ratio(HR)=3.725(3.051-4.549),P<0.001]and DFS [HR=2.431(2.029-2.912),P<0.001].The nomogram(alignment diagram) prediction model constructed based on multivariate COX regression could effectively evaluate the prognosis of stage Ⅱ CRC patients and provide guidance for practical clinical work.Conclusion:In stage Ⅱ CRC patients,older age is associated with shorter OS and DFS.Adequate intensity of adjuvant chemotherapy may be necessary.Treatment decisions can be adjusted based on the predicted model scores of the patient's alignment diagram.