淋巴结相关免疫指标对不同年龄的病理Ⅱ期结直肠癌患者无病生存率的影响

The significance of immunological indicators of lymph node for disease free survival of pathological stageⅡcolorectal cancer patients by age

目的:探究淋巴结相关免疫指标对不同年龄的病理Ⅱ期结直肠癌患者无病生存率的影响。方法:纳入2011年1月至2017年12月在中国医学科学院肿瘤医院结直肠外科接受手术治疗的813例病理Ⅱ期结直肠癌患者的临床病理资料,分为<60岁和≥60岁两组,比较两组临床病理指标特别是淋巴结相关免疫指标,并对两组进行单因素及多因素COX回归分析。结果:与≥60岁组相比,<60岁组BMI>24 kg/m^(2)、术后行辅助化疗及存在错配修复基因缺陷患者更多,而存在合并症的患者更少,差异均有统计学意义( χ^(2)=6.615, P=0.037;χ^(2)=35.086, P<0.001;χ^(2)=7.678, P=0.006;χ^(2)=13.905, P<0.001)。<60岁组病理淋巴结更大、淋巴结检出个数更多,差异均有统计学意义( t=2.149, P=0.032;t=3.892, P<0.001)。性别( P=0.043)、肿瘤位置( P=0.005)及病理淋巴结大小( P<0.001)是<60岁组的无病生存率独立危险因素;肿瘤位置( P=0.022)、分化程度( P=0.034)、病理T分期( P=0.041)及临床淋巴结分期( P=0.036)是≥60岁组无病生存率的独立危险因素。 结论:淋巴结相关免疫指标可以预测不同年龄的病理Ⅱ期结直肠癌患者的无病生存率。

Objective To explore the significance of immunological indicators of lymph node for disease free survival of pathological stageⅡcolorectal cancer based on two age groups.Methods Data of clinicopathological characteristics of 813 pathological stageⅡCRC patients undergoing surgery between Jan 2011 and Dec 2017 at Department of Colorectal Surgery,Cancer Hospital,Chinese Academy of Medical Sciences were retrospectively analyzed.Patients were divided into two groups based on age,including<60 years and≥60 years group.The clinicopathological characteristics especially the immunological indicators of lymph node between the two groups were compared.Then,the univariate and multivariate COX regression analysis were conducted in both groups.Results Compared to age≥60 years group,body mass index>24 kg/m 2,the number of patients with adjuvant therapy and with deficient mismatch repair were higher in age<60 years group,while the rate of comorbidity was less in age<60 years group,the differences were statistically significant(χ^(2)=6.615,P=0.037;χ^(2)=35.086,P<0.001;χ^(2)=7.678,P=0.006;χ^(2)=13.905,P<0.001).Meanwhile,patients with age<60 years group had larger lymph nodes and more harvested lymph nodes,the differences were statistically significant(t=2.149,P=0.032;t=3.892,P<0.001).Sex(P=0.043),tumor location(P=0.005)and size of lymph nodes(P<0.001)were independent risk factors in age<60 years group.Tumor location(P=0.022)and differentiation(well and moderate vs.poor,P=0.034),pathological T stage(P=0.041)and clinical lymph node stage(P=0.036)were independent risk factors in age≥60 years group.Conclusion The immunological indicators of lymph node could predict the disease free survival of pathological stageⅡcolorectal cancer in different age group.