高龄左、右半结肠癌患者切除术预后情况及其相关因素分析  

Analysis of prognosis and related factors in oldest-old patients with left-side or right-side colon cancer after hemicolectomy

作　　者：安琦[1] 史金鑫 崔健 李子建 马福海 肖刚[1] 贾文焯[1] 唐大年[1] 赵刚[1] 吴国举[1] An Qi;Shi Jinxin;Cui Jian;Li Zijian;Ma Fuhai;Xiao Gang;Jia Wenzhuo;Tang Danian;Zhao Gang;Wu Guoju(Department of General Surgery,Department of Gastrointestinal Surgery,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院普通外科胃肠外科国家老年医学中心,中国医学科学院老年医学研究院,北京100730

出　　处：《中华医学杂志》2023年第22期1666-1672,共7页National Medical Journal of China

基　　金：中央高水平医院临床科研业务费(BJ-2021-202,BJ-2022-152)

摘　　要：目的分析高龄左、右半结肠癌患者术后预后情况及其相关因素。方法回顾性收集2010年12月至2020年12月北京医院胃肠外科接受手术治疗的高龄(≥75岁)结肠癌患者临床病历资料,共238例,通过手术方式分为右半结肠切除术(RCC)组(130例)和左半结肠切除术(LCC)组(108例),比较2组患者的临床资料、术后短期并发症及长期预后差异,采用多因素Cox比例风险回归模型分析2组患者术后死亡的相关因素。结果238例高龄结肠癌患者的年龄为(80.5±3.7)岁(75~93岁);男128例,女110例。LCC组及RCC组患者年龄分别为(80.4±3.7)和(80.6±3.7)岁(P=0.699),2组患者性别构成、体质指数(BMI)、共存慢性疾病差异均无统计学意义(均P>0.05);LCC组患者的手术时间>170 min比例高于RCC组[56.5%(61例)比43.1%(56例),P=0.039]。2组患者术后短期并发症的发生率差异均无统计学意义(均P>0.05),5年总体生存率(OS)、肿瘤特异性生存率(CSS)及无病生存率(DFS)差异亦均无统计学意义(均P>0.05)。病理分期为Ⅳ(HR=28.970,95%CI:1.768~474.813,P=0.018)、术中出血>100 ml(HR=2.297,95%CI:1.351~3.907,P=0.002)及有癌结节(HR=2.044,95%CI:1.047~3.989,P=0.036)是LCC组患者手术后死亡的相关因素;体重过轻(HR=0.428,95%CI:0.192~0.955,P=0.038)、超重(HR=0.316,95%CI:0.125~0.800,P=0.015)、肥胖(HR=0.211,95%CI:0.067~0.658,P=0.007)、淋巴结转移(HR=2.682,95%CI:1.497~4.807,P=0.001)、有癌结节(HR=2.507,95%CI:1.301~4.831,P=0.027)及术后住院日超过9 d(HR=1.829,95%CI:1.070~3.128,P=0.006)是RCC组患者手术后死亡的相关因素。结论75岁及以上LCC高龄结肠癌患者手术时间较RCC者长;但2组术后并发症发生率差异无统计学意义;病理分期高、术中出血多及癌结节为LCC组患者预后不良的相关因素;BMI异常、淋巴结转移、癌结节及术后住院日延长是RCC组患者预后不良的相关因素。Objective This study aimed to explore the difference of prognosis in oldest-old colon cancer patients between the left-side and right-side hemicolectomy.Methods A total of 238 oldest-old(≥75 years old)colon cancer patients who received surgical treatment in Gastrointestinal Surgery Department of Beijing Hospital from December 2010 to December 2020 were retrospectively collected.They were divided into right-side hemicolectomy(RCC)group(130 cases)and left-side hemicolectomy(LCC)group(108 cases)by surgical methods.The difference in postoperative short-term complications and long-term prognosis was compared between the two groups,and the related factors of postoperative death was analyzed using multivariate Cox regression model.Results The age of 238 oldest-old patients with colon cancer ranged from 75 to 93 years old(80.5±3.7).There were 128 males and 110 females.The ages of patients in the LCC group and RCC group were(80.4±3.7)and(80.6±3.7)years old(P=0.699),respectively.There was no significant difference in gender,body mass index(BMI)and co-existing chronic diseases between two groups(P>0.05).The proportion of the duration of surgery exceeding 170 min in the LCC group was significantly higher than that in the RCC group(56.5%vs 43.1%,P=0.039).The incidence of postoperative short-term complications in RCC group was slightly higher than LCC group(P>0.05),and there was no significant difference in overall survival(OS),tumor-specific survival(CSS)and disease-free survival(DFS)between two groups.However,the two groups had different prognostic risk factors,pathologicalⅣstage(HR=28.970,95%CI:1.768-474.813,P=0.018),intraoperative bleeding(HR=2.297,95%CI:1.351-3.907,P=0.002)and cancer nodules(HR=2.044,95%CI:1.047-3.989,P=0.036)were independent prognostic risk factors in LCC group.Underweight(HR=0.428,95%CI:0.192-0.955,P=0.038),overweight(HR=0.316,95%CI:0.125-0.800,P=0.015),obesity(HR=0.211,95%CI:0.067-0.658,P=0.007),lymph node metastasis(HR=2.682,95%CI:1.497-4.807,P=0.001),tumor nodule(HR=2.507,95%CI:1.301-4.831,P=0

关 键 词：结肠肿瘤 高龄 左半结肠 右半结肠 并发症 预后 

分 类 号：R735.35[医药卫生—肿瘤]