186例老年大肠癌临床特点与预后分析——附290例非老年大肠癌对照  

A COMPARATIVE STUDY ON COLORECTAL CA RCINOMA IN THE ELDERLY(AN ANALYSIS OF 476CASES )

作　　者：朱捷[1] 钱敏[1] 周俊文[1] 王少林[1] 

机构地区：[1]华东医院普外科,上海市200040

出　　处：《老年医学与保健》2002年第3期153-155,共3页Geriatrics & Health Care

摘　　要：目的探讨老年人大肠癌的临床特点及影响其预后的因素。方法比较、分析我院自1990年至1997年收治的老年(≥60岁)与非老年大肠癌术后患者在11个临床观察项目中的构成比及五年生存率的差异,并用多因素回归分析得出老年大肠癌术后的独立预后指标。结果在两组患者的构成比上:老年组中有肠癌家族史的比例较低,合并其他器官疾病的比例较高,右半结肠肿瘤较多,Dukes分期较晚,手术根治率低,术后并发症较多,与非老年组相比上述差异明显(P值均小于0.05)。生存率比较:两组患者总的五年生存率差异并不明显(P=0.43),但老年组中DukesC、D期患者、姑息性手术后或坚持综合治疗者的五年生存率较非老年组为高(P值小于0.05)。肿瘤分期、手术方法、综合治疗是影响老年大肠癌长期生存的独立预后因素,而性别、有无家族史或合并疾病、CEA水平、肿瘤部位、分化程度、术后并发症的有无及术后化疗对老年大肠癌的预后影响不明显。结论初步发现老年大肠癌具有家族史的比例较低、合并病较多、肿瘤发生位置上移、病期较晚、手术根治率低及术后并发症多的特点,但如能及早发现肿瘤、积极采取适当的手术方法并辅以综合治疗措施,其预后较好。Objective To investigate the clinical characteristic s and prognostic factors of c olorectal carcinoma in the elderly.Methods From 1 990to 1997,186cases of elderly patients(≥60y)and 290cases of control(<60y)who un-derwent a surgical operation for pro ved colorectal ca rcinoma were compared by the 5-year survival rates and 11tumor -linked clin ical factors.The factors contr ibuted to the long -term survival of t he elder ly were analyzed by Cox -regression.Results Compared to the control group,the elder -group contributed a smaller pro portion of family heredity,a greate r proportion of having co -existing disease.The incidence of proximal colon canc er was h igher in the elderly.Their Dukes cla ssification were advanced.The pe rcentage of radical resection decreased and the morbidi ty of postoperative comp lications i ncreased in the elderly.The differences were signi ficant (P<0. 05).In regard to 5-year survival rate,2groups were similar,However,the survival rate of the elderly who had b een at C?D stage or received a palliati ve operation or received a multiple combined therapy was higher than that of the co ntrol(P<0.05).Tumor stage,method of surgical operation and multiple combined therapy were 3important prognostic factors for elderly colorectal can cer.Conclusions The elderly colorectal carcinoma sh ow a less tendency of here dity influence,more co -existing diseases,more p roximal distribution,later Dukes s tage,less chance of radical resection and higher rate of postoperative complications.Ne vertheless,the prognosis in the eld erly was not too bad,if early diagnosis,suitable surgic al operation and multiple combined t herapy wer e well -done.[

关 键 词：老年人 影响因素 大肠癌 临床特点 预后 

分 类 号：R735.34[医药卫生—肿瘤]