肿瘤大小对3114例Ⅱ期结直肠癌患者预后的影响  

Prognostic value of tumor size in 3114 patients with stageⅡcolorectal cancer

作　　者：李宪哲 熊志中 谢明颢 殷实 陈华显[1] 张冯祥 靳龙洋 兰平[1,2] 练磊 Li Xianzhe;Xiong Zhizhong;Xie Minghao;Yin Shi;Chen Huaxian;Zhang Fengxiang;Jin Longyang;Lan Ping;Lian Lei(Department of Colorectal Surgery,the Sixth Affiliated Hospital of Sun Yat-sen University,Guangzhou 510655,China;Guangdong Institute of Gastroenterology,Guangdong Province Key Laboratory of Colorectal and Pelvic Floor Diseases,the Sixth Affiliated Hospital of Sun Yat-sen University,Guangzhou 510655,China)

机构地区：[1]中山大学附属第六医院结直肠外科,广州510655 [2]广东省结直肠盆底疾病研究重点实验室/广东省胃肠病学研究所,广州510655

出　　处：《中华结直肠疾病电子杂志》2021年第2期149-157,共9页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：国家自然科学基金面上项目(No.81770557,No.82070684);广东省自然科学基金杰出青年项目(No.2020B151502067)。

摘　　要：目的探讨肿瘤大小对Ⅱ期结直肠癌患者预后的影响,并分析其临床应用价值。方法回顾性分析2007年10月至2020年3月在中山大学附属第六医院收治的Ⅱ期结直肠癌患者的临床病理资料。根据现有指南报道的高危因素,将患者分为高危和低危两组。采用Kaplan-Meier法绘制生存曲线,log-rank检验比较患者生存差异,并通过单、多因素Cox回归分析确定影响Ⅱ期结直肠癌患者预后的独立危险因素。基于多因素分析结果,构建列线图预测模型。结果共有3114例患者被纳入分析,其中高危组患者1149例和低危组患者1965例。仅在低危组患者的生存分析中,发现肿瘤≤5 cm比肿瘤>5 cm的患者的5年无病生存率更低(83.1%vs.89.8%),两者比较差异有统计学意义(χ^(2)=6.004,P=0.014)。多因素Cox回归分析显示,肿瘤≤5 cm、年龄>60岁、CEA>5 ng/mL、CA125>35 U/mL及合并术后并发症是影响低危组患者预后的独立危险因素。基于以上五种独立预后因素构建低危组患者的列线图预后预测模型。通过一致性指数(0.631)、受试者工作特征曲线下面积(1年为0.796,3年为0.760和5年为0.654)和校准曲线(与标准曲线拟合较好)对模型进行评估,显示模型预测的准确性较好。结论肿瘤大小是Ⅱ期低危结直肠癌患者的独立预后因素,而与Ⅱ期高危结直肠癌患者的预后无关。本研究构建的列线图预测模型可较准确地预测Ⅱ期低危结直肠癌患者的1年、3年、5年无病生存率。Objective To identify the prognostic and clinical application values of tumor size in patients with stageⅡcolorectal cancer(CRC).Methods The clinicopathological characteristics of patients with stageⅡCRC treated in the Sixth Hospital of Sun Yat-sen University from October 2007 to March 2020 were retrospectively analyzed.Patients were divided into high-risk and low-risk groups in terms of the highrisk factors reported in guidelines.Kaplan-Meier method was used to draw survival curves,and log-rank test was used to compare survival differences.The independent risk factors affected the prognosis of patients with stageⅡCRC were determined through univariable and multivariable Cox regression analyses.Based on the results of multivariate Cox regression analysis,a nomogram was constructed.Results A total of 3114 patients were included in the study,including 1149 patients in the high-risk group and 1965 patients in thelow-risk group.Only in the low-risk group,relative to the patients with a tumor size>5 cm,the patients with a tumor size≤5 cm had significantly poorer 5-year disease-free survival rate(DFS)(83.1%vs.89.8%,χ^(2)=6.004,P=0.014).Multivariable Cox regression analysis showed that tumor size≤5 cm,age>60 years,CEA>5 ng/m L,CA125>35 U/m L and postoperative complications were independent prognostic risk factors for patients in the low-risk group.Based on the above five factors,a nomogram for low-risk group was constructed.The model was evaluated by concordance index(0.663),areas under the receiver operating characteristic curve(0.796 for 1-year,0.760 for 3-year and 0.654 for 5-year)and calibration curves fitted well with reference line,which showed the model had good performance.Conclusions Tumor size is an independent prognostic factor for patients with stageⅡlow-risk CRC,but not for patients with stageⅡhighrisk colorectal cancer.The nomogram constructed in the study can accurately predict the 1-,3-,and 5-year disease-free survival rates of patients with stageⅡlow-risk CRC.

关 键 词：结直肠肿瘤 Ⅱ期 肿瘤大小 预后 列线图 

分 类 号：R735.34[医药卫生—肿瘤]