R0切除高危Ⅱ～Ⅲ期结直肠癌辅助化疗后生存预测因子的研究  

Survival predictive factors in completely resected high-risk Ⅱ/Ⅲ stage colorectal cancer after adjuvant chemotherapy

作　　者：刘艳艳[1] 贾彦召[1] 赵燕[1] 姚志华[1] 郭宏强[1] 杨树军[1] 

机构地区：[1]郑州大学附属肿瘤医院河南省肿瘤医院内科,450008

出　　处：《肿瘤研究与临床》2011年第8期535-537,共3页Cancer Research and Clinic

摘　　要：目的探寻R0切除高危Ⅱ～Ⅲ期结直肠癌辅助化疗后的生存预测因子，旨在指导个体化治疗，寻找新的治疗方法。方法应用随机数字表法选择初治的R0切除高危Ⅱ～Ⅲ期结直肠癌辅助化疗后患者76例，随访无瘤生存期和总生存期。应用显微切割联合聚合酶链反应、毛细管电泳的方法检测肿瘤细胞胸苷酸合成酶基因多态性和微卫星不稳定性。应用SPSS13．0统计软件分析患者临床特征、肿瘤细胞胸苷酸合成酶基因多态性和微卫星不稳定性与预后生存的关系。结果无瘤生存达5年和未达5年两组间肿瘤细胞分化程度和病理评估的淋巴结数目差异有统计学意义（x^27．827、P=0．018和t=9．265、P=0．003）；多因素COX回归分析显示肿瘤细胞分化程度和病理评估的淋巴结数目是患者生存预后的独立因子（x^2=40．472和39．528，均P=0．000）；Kaplan．Meier生存分析显示低分化腺癌的平均无瘤生存期和总生存期分别为27．67和43．13个月，均低于中高分化腺癌的61．13和64．21个月（X^2=45．015和35．514，均P=0．000），病理评估的淋巴结数目〈11个的患者分别为45．65和53．10个月，低于≥11个者的68．47和70．18个月（x^2=23．134，P=0．011；X^2=22．896，P：0．013）。结论低分化腺癌和病理评估的淋巴结数目〈11个是R0切除高危Ⅱ／Ⅲ期结直肠癌辅助化疗后的不良预后因子。Objective To analyze predictive factors on survival in patients with completely resected high-risk Ⅱ/Ⅲ stage eolorectal cancer after adjuvant chemotherapy. Methods According to random number table, 76 cases with completely resected high-risk Ⅱ/Ⅲ stage colorectal cancer after adjuvant chemotherapy were selected, who newly diagnosed and hospitalized in 2004. Their disease-free and overall survivals were followed up. Thymidylate synthase gene polymorphism and microsatellite instability were tested in these cases with microdissection combined with polymerase chain reaction and capillary electrophoresis. Correlation of these factors including clinical characteristics, thymidylate synthase gene polymorphism and microsatellite instability to survival was analyzed with SPSS13.0 software. Results Histologic grades and evaluated lymph node number had significantly difference between two groups of distinct prognosis （X^2 = 7.827, P =0.003 and X^2 = 9.265, P =0.018, respectively）, which were also independent predictors on survival proved by COX regression analysis （X^2 = 40.472, P =0.000 and X^2 = 39.528, P =0.000, respectively）. Kaplan-Meier survival analysis showed that the median disease-free and overall survival of poor-differentiated adenocarcinoma patients were significantly shorter than those of high and intermediate-differentiated ones （27.67 vs 61.13 months, X^2 = 45.015, P =0.000 and 43.13 vs 64.21 months, X^2 = 35.514, P =0.000, respectively）, as well, the median disease-free and overall survival of patients with the evaluated lymph node number less than 11 were poorer than those of more than 11 （ 45.65 vs 68.47 months, X^2 = 23.134, P =0.011 and 53.10 vs 70.18 months, X^2 = 22.896, P =0.013, respectively）. Conclusion Poor-differentiated adenocarcinoma and evaluated lymph node number less than 11 may be predictors on poor survival in patients with completely resected high- risk Ⅱ/Ⅲ stage colorectal cancer after adjuvant chemotherapy.

关 键 词：结直肠肿瘤 外科手术 抗肿瘤联合化疗方案 预后 预测 

分 类 号：R735.3[医药卫生—肿瘤]