75岁以上老年Ⅱ期结直肠癌根治术后患者复发因素分析  

Analysis of factors for recurrence of stageⅡcolorectal cancer in patients aged 75 years and over after radical resection

作　　者：胡雪晴[1] 赵赟博[1] 张子瑾[1] 杜俊[2] 黄莹莹[1] 王晖[1] 李琳[1] Hu Xueqing;Zhao Yunbo;Zhang Zijin;Du Jun;Huang Yingying;Wang Hui;Li Lin(Department of Oncology,Beijing Hospital,Institute of Geriatric Medicine,Chinese Academy of Medical,National Center of Gerontology,Sciences,Beijing 100730,China;Department of Pathology,Beijing Hospital,National Center of Gerontology,Beijing 100730,China)

机构地区：[1]北京医院肿瘤内科国家老年医学中心中国医学科学院老年医学研究所,北京100730 [2]北京医院病理科国家老年医学中心,北京100730

出　　处：《中华老年医学杂志》2020年第5期564-568,共5页Chinese Journal of Geriatrics

基　　金：重大疾病新药临床评价技术平台建设(2017ZX09304026)。

摘　　要：目的探讨75岁以上老年TNM(T3~4N0M0)分期II期结直肠癌患者术后复发的影响因素。方法回顾性分析北京医院2012年1月至2017年8月收治的161例75岁以上行根治性结直肠癌切除术期患者的临床病理资料,随访49个月(2~84个月),采用Kaplan-Meier法进行生存分析,Log-Rank检验进行生存率分析,应用Cox比例风险回归模型进行多因素生存分析。结果单因素分析:年龄≥85岁、术前合并症≥2个系统、体重下降≥10%、术前肠梗阻或肠穿孔、术前癌胚抗原(CEA)升高、术前糖类抗原199(CA199)升高、原发肿瘤浸润深度T4、淋巴结清扫不足12枚、脉管浸润、神经浸润、错配修复蛋白表达缺失(dMMR)、危险分层、接受辅助化疗是影响75岁以上Ⅱ期老年结直肠癌患者根治术预后的因素。Cox多因素分析:术前合并症≥2个系统、体重下降≥10%、术前肠梗阻/穿孔、术前CEA升高、T4、淋巴结清扫<12枚、脉管浸润是预后不良的独立因素,接受辅助化疗是改善预后的独立因素。全组161例患者5年无疾病生存率为41.6%,KM曲线分析低危、普危、高危3组患者间的无疾病生存时间(DFS)具有统计学差异(χ^2=14.632,P=0.001)。KM曲线分析高危患者接受术后奥沙利铂联合卡培他滨双药辅助治疗组患者DFS优于卡培他滨单药和无辅助化疗组(χ^2=11.157,P=0.004)。结论严格选择的75岁以上Ⅱ期高危老年结直肠癌患者行奥沙利铂联合卡培他滨双药辅助化疗DFS有获益。Objective To investigate the influencing factors for the recurrence of TNM(T3~4N0M0)stageⅡcolorectal cancer in patients aged 75 years and over after radical resection.Methods Clinicopathologic data of 161 colorectal cancer patients aged 75 years and over undergone radical resection in our hospital from January 2012 to August 2017 were retrospectively analyzed.They were followed up for 49 months(range:2-84 months).Survival analysis was conducted by the Kaplan-Meier method and the survival rate was examined using the Log-rank method.Multivariate analysis was conducted by the proportional hazards regression model.Results Univariate analysis showed that age≥80 years,preoperative comorbidities involving more than 1 system,weight loss≥10%,preoperative intestinal obstruction or perforation,preoperative CEA elevation,preoperative CA199 elevation,depth of primary tumor invasion T4,dissection of lymph nodes<12,vascular invasion,nerve invasion,deficient mismatch repair(dMMR),risk stratification and adjuvant chemotherapy were related factors for the prognosis in patients with TNM stageⅡcolorectal cancer aged 75 years and over after radical resection.Multivariate analysis showed that preoperative comorbidities involving more than 1 system,weight loss≥10%,preoperative intestinal obstruction or perforation,preoperative CEA elevation,depth of primary tumor invasion T4,dissection of lymph nodes<12 and vascular invasion were independent risk factors for poor prognosis,and adjuvant chemotherapy was an independent factor for favorable prognosis.The 5-year-disease-free survival(DFS)rate was 41.6%in all patients.The Kaplan-Meier curves indicated that disease-free survival(DFS)between the low-risk,middle-risk and high-risk groups had a statistically significant difference(χ^2=14.632,P=0.001).Kaplan-Meier survival analysis showed that high-risk patients receiving Oxaliplatin combined with Capecitabine adjuvant chemotherapy had better DFS than those receiving Capecitabine or non-adjuvant chemotherapy(χ^2=11.157,P=0.004).Concl

关 键 词：结直肠肿瘤 预后 

分 类 号：R735.3[医药卫生—肿瘤]