不同分期结直肠癌患者的预后分析:一项基于SEER数据库的回顾性研究  

Prognosis factor of patients with colorectal cancer:a retrospective study of surveillance,epidemiology,and end results population-based data

作　　者：张卫刚[1] 张言言 张宪文[1] 滕世峰 姚厚山[1] 李新星[1] 胡志前[1] 

机构地区：[1]第二军医大学附属长征医院普外一科,上海200003

出　　处：《中华结直肠疾病电子杂志》2017年第1期21-27,共7页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：国家自然科学基金青年科学基金项目(No.8140101730)

摘　　要：目的探讨不同分期结直肠癌患者的预后,并分析临床病理参数的预后预测价值。方法通过美国SEER*Stat软件搜集2004至2009年病理明确诊断为结直肠癌并接受肠癌根治手术的患者共87 885例。单因素和多因素Cox回归分析结直肠癌患者预后的影响因素;Kaplan-Meier法绘制患者的生存曲线;Log-rank检验分析比较生存率的差别。结果 87 885例结直肠癌患者的5年总体生存率为60.4%,中位生存时间为98个月,平均生存时间为(76.71±0.16)月。Ⅰ、Ⅱ、Ⅲ、Ⅳ期的五年生存率分别81.2%、71.7%、58.4%、14.4%;总体生存率比较的关系(由长时间到短时间)为:Ⅰ期>Ⅱ期>Ⅲ期>Ⅳ期,差异有统计学意义(χ2=26 063.383;P<0.001)。但是,Ⅱ期的总体生存率介于ⅢA与ⅢB之间。具体如下:ⅢA期的5年生存率(78.7%)与ⅠB期(79%)相当(χ2=0.040;P=0.841),明显优于ⅡA(73.6%)(χ2=39.409;P<0.001)、ⅡB(60.1%)(χ2=212.271;P<0.001)和ⅡC期(54.6%)(χ2=307.720;P<0.001),总体生存率比较的关系为:ⅢA期约等于ⅠB期,优于ⅡA、ⅡB、ⅡC任何一期。ⅢB期的5年生存率(61.5%)优于ⅡB(60.1%)(χ2=4.366;P=0.037)和ⅡC期(54.6%)(χ2=33.047;P<0.001),但差于ⅡA(73.6%)(χ2=692.563;P<0.001),总体生存率比较的关系为:ⅢB期差于ⅡA期,优于ⅡB、ⅡC。单因素分析显示,性别(χ2=5.662;P=0.017)、诊断年份(χ2=100.476;P<0.001)、人种(χ2=227.960;P<0.001)、肿瘤部位(χ2=457.809;P<0.001)、分化程度(χ2=2 364.001;P<0.001)、邻近器官有无受累(χ2=3 475.630;P<0.001)、浸润深度(χ2=8 281.813;P<0.001)、阳性淋巴结数(χ2=12 034.484;P<0.001)、检出淋巴结数(χ2=362.497;P<0.001)及有无远处转移(χ2=23 960.974;P<0.001)与预后相关。多因素Cox回归分析显示,性别(95%CI:0.958~0.997;P=0.025)、诊断年份(95%CI:0.967~0.992;P=0.001)、人种(95%CI:0.912~0.942;P<0.001)、肿瘤部位(95%CI:0.896~0.912;P<0.001)、分化程度(95%CI:1.162~1.204;P<0.001)、邻近器官有无受累(95%CI:0.758~0.832;P<0.001)、浸润Objective To explore the survival of different stage of patients with colorectal cancer, and evaluate the clinicopathologic factors associated with prognosis. Methods The SEER＊Stat software was used to identify patients whose pathological diagnosis as colorectal malignancy from 2004 to 2009, and underwent surgical treatment. Univariate and Cox multivariate regression analysis were applied to evaluate the prognostic factors. The Kaplan-Meier method was used to calculate the cumulative survival rate, and the significant difference was evaluated by the log-rank test. Results The mean survival time of 1 829 colorectal cancer patients was（76.71±0.16） months, the median survival time was 98 months and the overall 5-year survival was 60.4%. The 5-year survival rates of the stage Ⅰ, Ⅱ, Ⅲ, Ⅳ patients were 81.2%, 71.7%, 58.4%, 14.4%, and the relationship between the overall survival was stage Ⅰ stage Ⅱ stage Ⅲ stage Ⅳ（χ2=26 063.383; P 0.001）. But, the overall survival of stage Ⅱ was located between stage Ⅲ A and Ⅲ B. The overall 5-year survival of stage Ⅲ A（78.7%） and Ⅰ B（79%） was almost（χ2=0.040; P=0.841）, and better than Ⅱ A（χ2=39.409; P 0.001）, Ⅱ B（χ2=212.271; P 0.001）, Ⅱ C（χ2=307.720; P 0.001）. The overall 5-year survival of stage Ⅲ B（61.5%） was better than stage Ⅱ B（60.1%）（χ2=4.366; P=0.037） and Ⅱ C（54.6%）（χ2=33.047; P 0.001）, but worse than stage Ⅱ A（73.6%）（χ2=692.563; P 0.001）. The factors of sex（χ2=5.662; P=0.017）, years of diagnosis（χ2=100.476; P 0.001）, race（χ2=227.960; P 0.001）, primary site（χ2=457.809; P 0.001）, pathological grading（χ2=2 364.001; P 0.001）, adjacent organ involvement（χ2=3 475.630; P 0.001）, depth of invasion（χ2=8 281.813; P 0.001）, lymph node metastasis（χ2=12 034.484; P 0.001）, total number of lymph nodes（χ2=362.497; P 0.001） and metastasis（χ2=23 960.974; P 0.001） influenced the survival rate by univariate analysis. The factors of sex（

关 键 词：结直肠肿瘤 预后 TNM分期 生存 

分 类 号：R735.34[医药卫生—肿瘤]