结直肠黏液腺癌术后患者的预后影响因素分析

Analysis of prognostic factors in patients with colorectal mucinous adenocarcinoma after radical surgery

  • 摘要: 目的 探讨结直肠黏液腺癌(MA)术后患者的预后影响因素。 方法 收集结直肠MA根治性手术病例81例。使用Kaplan-Meier法分析无病生存期(DFS)和总生存期(OS),单因素和多因素Cox分析结直肠MA术后患者的预后影响因素。 结果 结直肠MA、结肠MA、直肠MA的5年无瘤生存率分别是55%、57%和47%;5年总生存率分别为60%、62%和51%。单因素Cox分析发现T4(HR = 2.174)、N2(HR = 3.592)、TNM Ⅲ期(HR = 2.435)、糖类抗原199(CA199) ≥34 U/ml(HR = 3.330)为结直肠MA患者DFS的危险因素;手术时间> 200 min(HR = 2.594)、T4(HR = 2.465)、N2(HR = 5.413)、TNM Ⅲ期(HR = 3.275)、CA199≥34 U/ml(HR = 4.150)和癌胚抗原(CEA)≥5 ng/ml(HR = 2.636)为结直肠MA患者OS的危险因素。多因素Cox分析显示,N2和CA199 ≥34 U/ml是结直肠MA预后的危险因素,N2的DFS和OS的HR分别为2.763和4.113,CA199≥34 U/ml的DFS和OS的HR值分别为2.560和2.948。分层分析发现,N2(HR = 5.628)是结肠MA患者DFS的危险因素,N2(HR = 7.547)和CA199 ≥ 34 U/ml (HR = 2.947)是结肠MA患者OS的危险因素;行辅助化学治疗是直肠MA预后的保护因素,DFS和OS的HR值分别为0.063和0.182(P均< 0.05)。 结论 N2分期、CA199≥34 U/ml是结直肠MA术后预后的独立危险因素,辅助化学治疗是直肠MA术后患者预后的保护因素。

     

    Abstract: Objective To explore the prognostic factors of patients with colorectal mucinous adenocarcinoma (MA) after radical surgery. Methods Eighty-one patients with colorectal MA undergoing radical surgery were recruited. Disease-free survival (DFS) and overall survival (OS) were analyzed using the Kaplan-Meier method. The prognostic factors of patients with colorectal MA were identified by using univariate and multivariate Cox’s regression analyses. Results The 5-year DFS of colorectal MA, colonic MA and rectal MA were 55%, 57% and 47% respectively. The 5-year OS were 60%, 62%, 51%, respectively. Univariate Cox’s regression analysis found that T4(HR = 2.174), N2(HR = 3.592), TNM stageⅢ(HR = 2.435), CA199≥34 U/ml(HR = 3.33) were the risk factors for DFS of patients with colorectal MA. The operation time > 200 minutes (HR = 2.594), T4 (HR = 2.465), N2 (HR = 5.413), TNM stage Ⅲ (HR = 3.275), CA199≥34 U/ml(HR = 4.150) and CEA≥5 ng/ml(HR = 2.636) were the risk factors for OS of colorectal MA patients. Multivariate Cox’s regression analysis demonstrated that N2 and CA199 ≥ 34 U/ml were the risk factors for the prognosis of colorectal MA patients. The HR of DFS and OS for N2 were 2.763 and 4.113. The HR of DFS and OS for CA199≥ 34 U/ml were 2.560 and 2.948. Stratified analysis revealed that N2(HR = 5.628)was the risk factor for DFS of colonic MA. N2(HR = 7.547) and CA199 ≥ 34 U/ml (HR = 2.947) were risk factors for OS of colonic MA. Adjuvant chemotherapy was a protective factor for the prognosis of rectal MA patients, the HR of DFS and OS were 0.063 and 0.182 (both P < 0.05). Conclusions N2 stage and CA199≥34 U/ml are the risk factors for clinical prognosis of patients with colorectal MA. Adjuvant chemotherapy is a protective factor for clinical prognosis of patients with rectal MA.

     

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