Ⅰ～Ⅲ期根治术后左右半结肠癌预后差异分析  

Prognostic factors of patients with stagesⅠ-Ⅲ left-sided versus right-sided colon cancer receiving radical surgery

作　　者：陈文菊 吴书胜[2] 罗会芹[2] 马典庆 李慧[2] 胡小秀[2] 牛佳郁 柯丽红[2] 闫滢[2] 李慧敏[2] 王伟[1] 陈健 胡冰 何义富 

机构地区：[1]安徽医科大学附属省立医院肿瘤内科,安徽合肥230001 [2]安徽省肿瘤医院肿瘤内科,安徽合肥230001

出　　处：《肿瘤》2017年第9期981-988,共8页Tumor

摘　　要：目的:探讨Ⅰ~Ⅲ期根治术后左半结肠癌(left-sided colon cancer,LCC)与右半结肠癌(right-sided colon cancer,RCC)患者预后的影响因素。方法 :回顾性分析2008年2月—2012年2月在安徽医科大学附属省立医院接受根治术的332例Ⅰ~Ⅲ期结直肠癌(colorectal cancer,CRC)患者的临床资料。应用χ2检验分析原发肿瘤位置与临床病理特征之间的相关性;采用Kaplan-Meier法绘制生存曲线,log-rank法和COX回归模型分别进行CRC患者预后的单因素和多因素分析。结果 :所有患者的5年总生存率为69.9%。LCC与RCC患者5年总生存率的差异有统计学意义(72.6%vs 66.9%,P=0.020)。其中,Ⅲ期LCC患者的5年总生存率高于RCC患者(62.5%vs 52.2%,P=0.018),但Ⅰ、Ⅱ期LCC患者与RCC患者5年总生存率的差异均无统计学意义(P>0.05)。LCC与RCC患者的肿瘤T分期、组织学分类、分化程度、肿瘤最大直径以及血红蛋白、血清白蛋白、血浆纤维蛋白原和血清癌胚抗原水平的差异有统计学意义(P值均<0.05)。单因素分析结果显示,肿瘤部位、T分期、N分期、组织学分类、分化程度、肿瘤最大直径以及血红蛋白、血清白蛋白、血浆纤维蛋白原和血清癌胚抗原水平与5年总生存率有关(P值均<0.05)。多因素分析结果显示,肿瘤N分期、组织学分类、分化程度以及血红蛋白、血清白蛋白、血浆纤维蛋白原和血清癌胚抗原水平是CRC的独立预后因素(P值均<0.05)。结论 :对于Ⅰ~Ⅲ期根治术后CRC患者,肿瘤N分期较高、黏液腺癌/印戒细胞癌、低分化癌、贫血、低白蛋白血症、血浆纤维蛋白原≥4 g/L、血清癌胚抗原≥10 ng/m L提示预后不良。LCC与RCC的的临床病理特征和预后存在差异,但原发肿瘤位置不是独立的预后因素。Objective： To investigate the prognostic factors of patients with stages Ⅰ-Ⅲ left-sided colon cancer（LCC） versus right-sided colon cancer（RCC） receiving radical surgery.Methods： A retrospective analysis of clinical data from 332 patients with stages Ⅰ-Ⅲ colorectal cancer（CRC） who underwent radical surgery in Anhui Provincial Hospital, Anhui Medical University between February 2008 and February 2012 was conducted. The differences in clinicopathological characteristics by tumor location（RCC vs LCC） were examined by using χ2 test. The comparisons of overall 5-year survival rate between RCC and LCC within each stage and for all stages were done by using Kaplan-Meier method. The univariate analysis of prognosis was performed by using log-rank test, and the multivariate analysis was performed by using COX regression model.Results： The overall 5-year survival rate of all patients was 69.9%. The LCC patients had significantly higher overall 5-year survival rate than RCC patients（72.6% vs 66.9%, P = 0.020）. The stage Ⅲ LCC patients had significantly higher overall 5-year survival rate than the stage Ⅲ RCC patients（62.5% vs 52.2%,P = 0.018）, but no significant difference in overall 5-year survival rate was found between stage Ⅰ or Ⅱ RCC and LCC patients（P〉0.05）. There were significant differences in T stage, histologic type, degree of differentiation, tumor size, hemoglobin, albumin, fibrinogen and carcinoembryonic antigen（CEA） between RCC and LCC patients（all P 〈0.05）. The univariate analysis showed that tumor location, T stage, N stage, histologic type, degree of differentiation, tumor size, hemoglobin, albumin, fibrinogen and CEA were significantly correlated with overall 5-year survival rate of CRC patients（all P〈 0.05）. Multivatiate analysis showed that N stage, histologic type, degree of differentiation, hemoglobin, albumin, fibrinogen and CEA were independent prognostic factors of CRC（all P〈 0.05）.Conclusion： For patients with stages Ⅰ-�

关 键 词：结直肠肿瘤 左半结肠癌 右半结肠癌 临床病理特征 预后 

分 类 号：R735.3[医药卫生—肿瘤]