结直肠黏液腺癌术后患者的预后影响因素分析  

Analysis of prognostic factors in patients with colorectal mucinous adenocarcinoma after radical surgery

作　　者：黄庆 邹旻红[3] 蒋叶[4] 李旺林 曹杰 Huang Qing;Zou Minhong;Jiang Ye;Li Wanglin;Cao Jie(Department of General Surgery,Guangzhou First People’s Hospital,the Second Affiliated Hospital of South China University of Technology,Guangzhou 510180,China)

机构地区：[1]广州市第一人民医院华南理工大学附属第二医院综合外科,广州510180 [2]广州市第一人民医院华南理工大学附属第二医院消化疾病中心,广州510180 [3]中山大学附属第三医院超声科,广州510630 [4]中山大学附属第三医院病理科,广州510630

出　　处：《新医学》2021年第1期26-31,共6页Journal of New Medicine

基　　金：国家自然科学基金(81871943);广东省自然科学基金(2017A030311035);广东省医学科研基金(A2019526)。

摘　　要：目的探讨结直肠黏液腺癌(MA)术后患者的预后影响因素。方法收集结直肠MA根治性手术病例81例。使用Kaplan-Meier法分析无病生存期(DFS)和总生存期(OS),单因素和多因素Cox分析结直肠MA术后患者的预后影响因素。结果结直肠MA、结肠MA、直肠MA的5年无瘤生存率分别是55%、57%和47%;5年总生存率分别为60%、62%和51%。单因素Cox分析发现T4(HR=2.174)、N2(HR=3.592)、TNMⅢ期(HR=2.435)、糖类抗原199(CA199)≥34 U/ml(HR=3.330)为结直肠MA患者DFS的危险因素;手术时间>200 min(HR=2.594)、T4(HR=2.465)、N2(HR=5.413)、TNMⅢ期(HR=3.275)、CA199≥34 U/ml(HR=4.150)和癌胚抗原(CEA)≥5 ng/ml(HR=2.636)为结直肠MA患者OS的危险因素。多因素Cox分析显示,N2和CA199≥34 U/ml是结直肠MA预后的危险因素,N2的DFS和OS的HR分别为2.763和4.113,CA199≥34 U/ml的DFS和OS的HR值分别为2.560和2.948。分层分析发现,N2(HR=5.628)是结肠MA患者DFS的危险因素,N2(HR=7.547)和CA199≥34 U/ml(HR=2.947)是结肠MA患者OS的危险因素;行辅助化学治疗是直肠MA预后的保护因素,DFS和OS的HR值分别为0.063和0.182(P均<0.05)。结论N2分期、CA199≥34 U/ml是结直肠MA术后预后的独立危险因素,辅助化学治疗是直肠MA术后患者预后的保护因素。Objective To explore the prognostic factors of patients with colorectal mucinous adenocarcinoma(MA)after radical surgery.Methods Eighty-one patients with colorectal MA undergoing radical surgery were recruited.Disease-free survival(DFS)and overall survival(OS)were analyzed using the Kaplan-Meier method.The prognostic factors of patients with colorectal MA were identified by using univariate and multivariate Cox’s regression analyses.Results The 5-year DFS of colorectal MA,colonic MA and rectal MA were 55%,57%and 47%respectively.The 5-year OS were 60%,62%,51%,respectively.Univariate Cox’s regression analysis found that T4(HR=2.174),N2(HR=3.592),TNM stageⅢ(HR=2.435),CA199≥34 U/ml(HR=3.33)were the risk factors for DFS of patients with colorectal MA.The operation time>200 minutes(HR=2.594),T4(HR=2.465),N2(HR=5.413),TNM stageⅢ(HR=3.275),CA199≥34 U/ml(HR=4.150)and CEA≥5 ng/ml(HR=2.636)were the risk factors for OS of colorectal MA patients.Multivariate Cox’s regression analysis demonstrated that N2 and CA199≥34 U/ml were the risk factors for the prognosis of colorectal MA patients.The HR of DFS and OS for N2 were 2.763 and 4.113.The HR of DFS and OS for CA199≥34 U/ml were 2.560 and 2.948.Stratified analysis revealed that N2(HR=5.628)was the risk factor for DFS of colonic MA.N2(HR=7.547)and CA199≥34 U/ml(HR=2.947)were risk factors for OS of colonic MA.Adjuvant chemotherapy was a protective factor for the prognosis of rectal MA patients,the HR of DFS and OS were 0.063 and 0.182(both P<0.05).Conclusions N2 stage and CA199≥34 U/ml are the risk factors for clinical prognosis of patients with colorectal MA.Adjuvant chemotherapy is a protective factor for clinical prognosis of patients with rectal MA.

关 键 词：结直肠癌 黏液腺癌 预后 根治性手术 

分 类 号：R735.34[医药卫生—肿瘤]