与食管癌及结直肠癌术后患者预后相关的心血管疾病危险因素

Cardiovascular risk factors related to prognosis of patients with esophageal and colorectal cancer after operation

目的 探讨食管癌、结直肠癌术后患者预后的影响因素。方法 回顾性分析2016年366例Ⅱ、Ⅲ期食管癌、结直肠癌患者(110例食管癌患者,256例结直肠癌患者)的临床资料。所有患者均接受手术治疗,联合或不联合化疗、放疗。终点事件定义为全因死亡、急性心肌梗死、不稳定型心绞痛、需住院的心力衰竭、脑卒中,电话随访获得首次终点事件发生时间。采用Kaplan-Meier生存曲线比较多组间无终点事件生存率的差别。采用Cox回归分析方法分析与患者预后相关的心血管疾病危险因素。结果 中位随访50月,115例患者发生终点事件。Kaplan-Meier分析发现食管癌患者累积无终点事件生存率显著低于结直肠癌患者(Log-rank,χ^(2)=3.965,P=0.046)。在多因素Cox回归分析中,冠心病史(HR=2.622,95%CI 1.570~4.377,P<0.001)、术前中性粒细胞计数与淋巴细胞计数的比值(NLR)(HR=1.166,95%CI 1.054~1.291,P=0.003)、体重指数(HR=0.939,95%CI 0.886~0.995,P=0.034)、白蛋白(HR=0.950,95%CI 0.904~0.999,P=0.044)、TNM分期(Ⅲ期:HR=1.669,95%CI 1.129~2.469,P=0.010)是食管癌及结直肠癌患者发生终点事件的影响因素;NLR(HR=1.392,95%CI 1.166~1.661,P<0.001)、放疗(HR=0.380,95%CI 0.167~0.863,P=0.021)为食管癌术后患者终点事件发生的影响因素;既往冠心病史(HR=2.744,95%CI 1.473~5.114,P=0.001)、TNM分期(Ⅲ期:HR=1.852,95%CI 1.116~3.074,P=0.017)与结直肠癌患者终点事件的发生有关。结论 体重指数、NLR、既往冠心病史与食管癌及结直肠癌术后患者终点事件的发生密切关联;NLR水平越高,食管癌术后患者发生终点事件风险越高,既往冠心病史增加结直肠癌术后患者终点事件的发生风险。

Objective To explore the cardiovascular factors related to prognosis in postoperative patients with esophageal cancer and colorectal cancer.Methods The clinical data of 366 patients with stage Ⅱ and Ⅲ esophageal cancer and colorectal cancer(110 patients with esophageal cancer and 256 patients with colorectal cancer) in 2016 were analyzed retrospectively.All patients underwent surgical treatment,with or without chemotherapy or radiation therapy.The end-point events were defined as all-cause death,acute myocardial infarction,unstable angina pectoris,heart failure requiring hospitalization and stroke,and the time of the first occurrence of endpoint was obtained by telephone follow-up.Survival analysis was performed by Kaplan-Meier survival curve.Cox proportional hazards model was used to analyze the related cardiovascular risk factors affecting the prognosis.Results After a median follow-up of 50 months,115 patients developed outcomes events.Kaplan-Meier analysis showed that the survival rate without endpoint events in patients with esophageal cancer was significantly lower than that in patients with colorectal cancer(Log-rank,χ~2=3.965,P=0.046).Multivariate Cox regression analysis showed that the history of coronary heart disease(HR=2.622,95%CI 1.570-4.377,P<0.001),preoperative neutrophil to lymphocyte ratio(NLR)(HR=1.166,95%CI 1.054-1.291,P=0.003),body mass index(BMI)(HR=0.939,95%CI 0.886-0.995,P=0.034),serum albumin(HR=0.950,95%CI 0.904-0.999,P=0.044) and TNM stage(stage Ⅲ:HR=1.669,95%CI 1.129-2.469,P=0.010) were influencing factors for endpoint events in patients with esophageal cancer and colorectal cancer;NLR(HR=1.392,95%CI 1.166-1.661,P<0.001) and radiotherapy(HR=0.380,95%CI 0.167-0.863,P=0.021) were influencing factors for endpoint events in postoperative patients with esophageal cancer;previous history of coronary heart disease(HR=2.744,95%CI 1.473-5.114,P=0.001) and TNM stage(stage Ⅲ:HR=1.852,95%CI 1.116-3.074,P=0.017) were associated with endpoint events in patients with colorectal cancer.Conclusions BMI,NLR and previous history of coronary heart disease were associated with endpoint events in patients with esophageal cancer and colorectal cancer.High levels of NLR increased the risk of endpoint events in postoperative patients with esophageal cancer.Previous history of coronary heart disease increased the risk of endpoint events in postoperative patients with colorectal cancer.