90岁以上结直肠癌患者手术的价值及生存分析  

Analysis of surgical value and survival in patients over 90 years of age with colorectal cancer

作　　者：曾维根 庞国义[1] 赵琦[1] 谢德红[1] 渠浩[1] 韩加刚[1] 赵宝成[1] 王振军[1] ZENG Weigen;PANG Guoyi;ZHAO Qi;XIE Dehong;QU Hao;HAN Jiagang;ZHAO Baocheng;WANG Zhenjun(Department of General Surgery,Beijing Chao-yang Hospital,Capital Medical University,Beijing100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院普外科,北京100020

出　　处：《中国医药导报》2021年第23期96-99,共4页China Medical Herald

基　　金：首都卫生发展科研专项项目(首发2018-1-2032)。

摘　　要：目的探讨90岁以上结直肠癌患者手术的价值及预后分析。方法回顾性分析首都医科大学附属北京朝阳医院2003年5月至2019年10月收治的94例90岁以上结直肠癌患者的临床资料,根据是否进行手术将其分为手术组(72例)和非手术组(22例)。比较两组临床特征,分析患者预后的影响因素。结果非手术组年龄、美国东部肿瘤协作组(ECOG)体力状况评分、Charlson合并症指数、肿瘤分期均高于手术组,差异有统计学意义(P<0.05)。两组生存曲线比较,差异有统计学意义(P<0.05)。单因素分析结果显示ECOG评分≥4分(HR=2.024,95%CI:1.056~3.879,P=0.034)、肿瘤分期为Ⅲ~Ⅳ期(HR=3.952,95%CI:2.201~7.097,P<0.001)、Charlson合并症指数≥10(HR=3.607,95%CI:2.079~6.258,P<0.001)、手术治疗(HR=4.465,95%CI:2.382~8.371,P<0.001)均与预后相关。多因素分析结果显示肿瘤分期为Ⅲ~Ⅳ期(HR=3.389,95%CI:1.830~6.279,P<0.001)、Charlson合并症指数≥10(HR=2.570,95%CI:1.396~4.732,P=0.002)、未行手术治疗(HR=2.190,95%CI:1.071~4.476,P=0.032)为预后差的独立危险因素。结论年龄≥90岁不应成为结直肠癌患者手术禁忌证,手术可以显著延长患者的寿命。Objective To analyze the surgical value and prognosis of patients with colorectal cancer aged over 90 years.Methods The clinical data of 94 patients over 90 years old with colorectal cancer admitted to Beijing Chao-yang Hospital,Capital Medical University from May 2003 to October 2019 were retrospectively analyzed,and they were divided into surgery group(72 cases)and non-surgery group(22 cases)according to whether they had undergone surgery or not.The clinical characteristics of the two groups were compared,and the influencing factors for the prognosis of patients were analyzed.Results The age,Eastern Cooperative Oncology Group(ECOG)physical status score,Charlson comorbidity index,and tumor stage in the non-surgery group were higher than those in the surgery group,and the differences were statistically significant(P<0.05).The difference of survival curve between the two groups was statistically significant(P<0.05).Univariate analysis showed that ECOG score≥four points(HR=2.024,95%CI:1.056-3.879,P=0.034),the tumor stage at stageⅢ-Ⅳ(HR=3.952,95%CI:2.201-7.097,P<0.001),Charlson comorbidity index≥ten(HR=3.607,95%CI:2.079-6.258,P<0.001),no surgical treatment(HR=4.465,95%CI:2.382-8.371,P<0.001)were correlated with prognosis.Multivariate analysis showed that the tumor stages at stageⅢ-Ⅳ(HR=3.389,95%CI:1.830-6.279,P<0.001),Charlson comorbidity index≥ten(HR=2.570,95%CI:1.396-4.732,P=0.002),and the absence of surgical treatment(HR=2.190,95%CI:1.071-4.476,P=0.032)were independent risk factors for poor prognosis.Conclusion Age≥90 years old should not be a contraindication to surgery in patients with colorectal cancer,which can significantly prolong life.

关 键 词：结直肠癌 高龄 手术 预后 

分 类 号：R735.3[医药卫生—肿瘤]