Ⅲ期结肠癌老年患者根治术的预后相关因素及生存分析

Prognostic factors and survival analysis after radical operation in elderly patients with stage Ⅲ colon cancer

目的研究老年Ⅲ期结肠癌患者术后临床及病理因素对预后的影响,并进行相关因素分析,以期为临床预后评估提供参考。方法回顾性分析2008年1月至2012年12月208例接受根治性手术切除后的老年Ⅲ期结肠癌患者的临床资料,采用Kaplan-Meier法计算老年结肠癌患者总生存率,采用Log-rank检验和多因素Cox回归分析分析影响患者生存的因素。结果老年Ⅲ期结肠癌患者5年生存率为55. 5%。单因素分析显示,不同年龄、肿瘤大小、组织学类型、组织学分级、脉管癌栓侵犯、神经浸润、T分期、N分期、美国癌症联合委员会(AJCC)分期、术前癌胚抗原(CEA)水平、化疗与否患者中5年总生存率比较有统计学差异(P <0. 05,P <0. 01)。Cox多因素分析显示,年龄、脉管癌栓、T分期、N分期、AJCC分期、术前CEA水平、化疗为老年Ⅲ期结肠癌患者预后的影响因素(P <0. 05)。结论对于老年Ⅲ期结肠癌,TNM体系仍是判断预后的可靠指标,但需考虑年龄(≥70岁)、脉管癌栓、术前CEA因素对预后的影响。此外老年Ⅲ期结肠癌患者术后化疗能明显获益,应对术后辅助化疗持积极态度。

Objective To investigate the influence of postoperative clinical and pathological factors on prognosis in elderly patients with stage Ⅲ colon cancer,and survival analysis was conducted in order to provide reference for clinical prognosis evaluation. Methods The clinical and pathological data of 208 elderly patients with stage Ⅲ colon cancer after radical resection were retrospectively analyzed,and all cases were followed up. Kaplan-Meier method was used to calculate the overall survival rate of elderly patients with colon cancer. Log-rank test and multivariate COX regression analysis were used to analyze the factors of influencing patients’ survival. Results The 5-year survival rate of elderly patients with stage Ⅲcolon cancer was 55. 5%. Univariate analysis showed that age,tumor size,histological type,histological grade,vascular carcinoma embolus invasion,neural infiltration,T staging,N staging,American Joint Committee on Cancer( AJCC) staging,preoperative carcinoembryonic antigen( CEA) level and chemotherapy were poor prognostic factors( P < 0. 05,P < 0. 01).Further,Cox multivariate analysis showed that age,vascular carcinoma embolus,T staging,N staging,AJCC staging,preoperative CEA level and chemotherapy were the independent prognostic factors affecting survival( P < 0. 05,P < 0. 01).Conclusions For elderly patients with stage Ⅲ colon cancer,TNM system is still a reliable indicator judging prognosis,but the affects of age( > 70 years old),vascular carcinoma embolus and preoperative CEA level on prognosis should be considered. Additionally,postoperative chemotherapy can significantly benefit in elderly patients with stage Ⅲ colon cancer,so the patients should take a positive attitude towards postoperative adjuvant chemotherapy.