老年人直肠癌患者的预后因素分析

Analysis of Prognostic Factors of Rectal Cancer in the Elderly

背景与目的:患者年龄与结直肠癌手术后疗效的关系较复杂,一般认为年龄本身不是影响结直肠癌患者预后的决定因素。但文献中有关影响老年人直肠癌患者预后因素的研究较少。因此,回顾性分析343例老年人直肠癌病例的临床病理特征,对影响患者术后生存的因素进行单因素及多因素分析。方法:10年间手术治疗60岁以上老年直肠癌患者343例,其中R0(病理根治)术261例,占76.09%;R1(镜下切端阳性)29例,占8.45%;R2(大体标本切端阳性)53例,占15.45%。低位前切除术116例,Miles术169例,其他术式58例。结果:手术死亡率为0.87%,149例患者于术后108个月内死于复发和转移。随访期间发生肝转移17例,肺转移18例,骨转移1例。患者总的平均生存时间为(72.12±2.60)个月。3、5、10年的总生存率分别为69.62%、55.73%及34.23%。单因素分析表明,术式、手术性质、病理类型、肿瘤直径、肿瘤浸润深度、淋巴结转移、肝转移、肺转移及其他远处转移是影响患者术后生存的因素;多因素回归分析显示,淋巴结转移、肝转移及肺转移是影响患者生存的独立因素。结论:影响老年直肠癌患者术后生存的因素为术式、手术性质、病理类型、肿瘤直径、肿瘤浸润深度、淋巴结转移、远处转移。独立影响因素有手术性质、淋巴结转移、肝转移及肺转移。

BACKGROUND & OBJECTIVE:The relation between patient age and outc omes from colorectal cancer surgery is complex. It is generally believed that ag e should not be a determinant in consideration of prognosis for colorectal cance r patient. But there were few studies on the prognostic factors of rectal cancer in the elderly. We therefore performed a retrospective analysis of clinicopatho logic characteristics of rectal cancer in 343 old patients with rectal cancer by univariate and multivariate analysis. METHODS:A total of 343 patients (older th an 60 years) with rectal cancer were treated surgically during a period of 10 ye ars. R0, R1, and R2 operations were carried out in 261 patients (76.09%), 29 pa tients (8.45%), and 53 patients (15.45%), respectively. Low anterior resection was performed in 116 patients; 169 patients underwent Miles operation; 58 patie nts underwent the other operations. RESULTS:The operation mortality was 0.87%; 149 patients died of occurrence or metastases of the tumor within 108 months pos toperatively. Liver, lung, and bone metastases were occurred in 17, 18, and 1 pa tients, respectively. The mean survival time for all patients was 72.12±2.60 mo nths and the overall 3-, 5-, and 10-year survival rates were 69.62%, 55.73% , and 34.23%, respectively. Univariate analysis showed that the predictors of s urvival were type of operations, radical resection, histological type, diameter of the tumors, depth of tumor invasion, lymphatic invasion, distance metastases, liver and lung metastases. Multivariate analysis showed that only radical resec tion, lymphatic invasion, liver and lung metastases were independent factors. CO NCULSION:The follow prognostic factors can influence the survival of rectal canc er in the elderly: type of operations, nature of operation, histological type, d iameter of the tumors, depth of tumor invasion, lymphatic invasion, distance met astases, liver and lung metastases. The independent factors were nature of opera tion, lymphatic invasion, liver and lung metastases.