Ⅲ期结肠癌患者预后因素分析和术前对预后评估的探索  

Prognostic Factors Analysis and Preoperative Prognostic Evaluation for StageⅢ Colorectal Cancer

作　　者：潘宏达[1,2] 彭亦凡[1,2] 王林[1,2] 顾晋[1,2] 

机构地区：[1]北京大学肿瘤医院 北京肿瘤医院 [2]北京市肿瘤防治研究所结直肠肿瘤外科 恶性肿瘤发病机制及转化研究教育部重点实验室,北京100036

出　　处：《肿瘤防治研究》2013年第11期1059-1063,共5页Cancer Research on Prevention and Treatment

摘　　要：目的探讨Ⅲ期结肠癌的预后因素及术前预后评估的可行性。方法回顾性分析2004年1月至2008年6月间北京肿瘤医院外科手术治疗的Ⅲ期结肠癌患者临床病理资料,分析结肠癌的预后因素。对可能影响患者生存的因素进行单因素和Cox多因素模型分析。结果 (1)全部Ⅲ期患者3年无病生存率为63.4%;(2)单因素分析发现术前血清CEA水平>5 ng/ml、肿瘤分化程度低、肿瘤直径≥5 cm、更高的N分期、TNM分期和脉管癌栓(P<0.05)是影响Ⅲ期患者预后的因素;(3)多因素回归分析术前血清CEA水平(P=0.000,RR=2.832,1.755～6.023),N分期(P=0.001,RR=1.456,1.522～4.984),肿瘤直径≥5 cm(P=0.015,RR=1.663,1.155～3.871)是Ⅲ期患者生存的独立预后危险因素。结论根据术前血清CEA水平、肿瘤直径≥5 cm和更高N分期,可以对具有预后不良因素的Ⅲ期结肠癌患者进行更准确的风险分层,应针对Ⅲ期高危患者进行更积极的术前新辅助治疗以及更加密切的术后随访。Objective To investigate the prognostic factors of stage Ⅲ （pT1-4N1-2M0） colon cancer, and discuss the feasibility of preoperative prognosis evaluation. Methods Clinicopathologic data of patients with stage Ⅲ colon cancer treated with curative surgery alone from January 2004 to June 2008 in Peking University Cancer Hospital was retrospectively reviewed,to analyze the prognostic factors of demographics, clinical, histopathologic, and laboratory data. Univariate and multivariate analysis were conducted to identify prognostic factors associated with 3-year disease-free survival （3yr DFS）. Results There were 131 valid cases reviewed in this study, the 3yr DFS was 63.4%. Univariate analysis showed that preoperative CEA level ≥5 ng/ml, poor differentiation, tumor diameter ≥5 cm, higher N stage, TNM stage and lymphaticvessel invasion were the poor prognostic factors of patients with stage Ⅲ colon cancer （P〈0.05）. Multivariate analysis showed that preoperative CEA level （P=0.000, RR=2.832, 1.755-6.023）, higher N stage（P=0.001, RR=1.456, 1.522-4.984）, tumor diameter≥5 cm（P=0.015, RR=1.663, 1.155-3.871） were the independent prognostic factors for 3yr DFS. Conclusion According to the prognostic risk factors of preoperative CEA level,higher N stage and tumor diameter 〉75 cm, more accurate risk stratification more intensive treatment and more closely surveillance could be conducted in patients with stage Ⅲ colon cancer.

关 键 词：结肠癌 Ⅲ期 预后 术前 

分 类 号：R735.35[医药卫生—肿瘤]