青年与中老年结直肠癌患者临床病理特征差异性及预后分析  

Clinicopathological features and prognosis between young,middle-aged and elder⁃ly colorectal cancer patients

作　　者：张大平 王亚南[2] 陈国梁 侍新宇 杨洁 何宋兵[3] Zhang Daping;Wang Yanan;Chen Guoliang;Shi Xinyu;Yang jie;He Songbing(Department of Colorectal Surgery,The First People’s Hospital of Kunshan,Kunshan 215300,Jiangsu,China;Department of Clinical Laboratory,Suzhou Municipal Hospital,Suzhou 215006,Jiangsu,China;Department of General Surgery,The First Affiliated Hospital of Soochow University,Suzhou 215006,Jiangsu,China)

机构地区：[1]昆山市第一人民医院肛肠外科,江苏昆山215300 [2]苏州市立医院检验科,江苏苏州215006 [3]苏州大学附属第一医院普外科,江苏苏州215006

出　　处：《结直肠肛门外科》2021年第5期460-464,共5页Journal of Colorectal & Anal Surgery

基　　金：江苏省自然科学基金(BK20191172);江苏省“科教强卫工程”青年医学人才项目(QNRC2016735);苏州市姑苏卫生重点人才项目(GSWS2020005)。

摘　　要：目的分析青年与中老年结直肠癌患者临床病理特征及预后的差异性,探讨青年结直肠癌患者预后的影响因素。方法纳入昆山市第一人民医院2013年12月至2019年6月临床确诊的48例青年(≤45岁)结直肠癌患者为研究对象,定义为青年组。另随机选取同期48例中老年(>45岁)结直肠癌患者作为对照组。比较两组患者临床病理特征,采用Kaplan-Meier生存曲线分析两组总生存率的差异,采用单因素和多因素Cox比例风险回归模型探讨青年结直肠癌患者预后的影响因素。结果青年组肿瘤浸润深度为T_(3)~T_(4)患者比例、分化程度为中低分化患者比例及有神经浸润患者比例均高于对照组,差异有统计学意义(均P<0.05);两组性别、肿瘤大小、肿瘤部位、TNM分期、淋巴结转移情况、脉管浸润及首发症状等临床病理特征比较差异均无统计学意义(均P>0.05)。Kaplan-Meier生存分析结果显示,两组患者中位生存期分别为61个月和48个月,其中青年组总生存率低于对照组,差异有统计学意义(P=0.027)。单因素Cox比例风险回归模型分析结果显示肿瘤大小、TNM分期、分化程度、有无淋巴结转移、有无脉管浸润、有无神经浸润均与青年结直肠癌患者的预后有关(均P<0.05)。进一步行多因素分析结果显示,TNM分期、有无淋巴结转移、有无神经浸润是青年结直肠癌患者预后的独立影响因素(均P<0.05)。结论青年与中老年结直肠癌患者在肿瘤浸润深度、肿瘤分化程度及有无神经浸润方面存在差异,青年结直肠癌患者总生存率明显低于中老年患者,肿瘤TNM分期、有无淋巴结转移及有无神经浸润是青年结直肠癌患者预后的独立影响因素。Objectives To analyze clinicopathological features between young,middle-aged and elderly colorectal cancer pa⁃tients and analyze factors influencing the prognosis of colorectal cancer in young adults.Methods Forty-eight young adult pa⁃tients(≤45 years)with colorectal cancer treated at the First People’s Hospital of Kunshan between December 2013 and June 2019 were recruited as the young group.Forty-eight middle-aged and elderly patients(>45 years)with colorectal cancer treated at the same period were randomly selected as the control group.Clinicopathological features were compared between the two groups.Overall survival was analyzed in the two groups using the Kaplan-Meier survival curves.Factors influencing the progno⁃sis of colorectal cancer in the young group were analyzed using the univariate and multivariate Cox proportional hazard model.Results Compared with the control group,the young group had significantly higher proportion of T_(3) and T_(4) tumor invasion,high⁃er proportion of medium-low differentiation,and higher proportion of neural infiltration(P<0.05).The two groups did not differ significantly in multiple clinicopathological features such as sex,tumor size,tumor location,TNM staging,lymph node metastasis,vascular infiltration,and the initial symptoms(P>0.05).Kaplan-Meier survival analysis showed that the median survival time was 61 months and 48 months,with significantly lower survival rate in the young group(P=0.027).Univariate Cox proportional haz⁃ard model showed that tumor size,TNM staging,degree of differentiation,lymph node metastasis or not,with or without vascular infiltration,and with or without neural infiltration were significantly associated with prognosis in the young adult patients with colorectal cancer(P<0.05).Multivariate analyses showed that TNM staging,lymph node metastasis or not,and with or without neural infiltration were independent factors influencing prognosis in the young adult patients with colorectal cancer(P<0.05).Conclusion In colorectal cancer,young adul

关 键 词：结直肠癌 青年患者 中老年患者 临床病理特征 预后 

分 类 号：R735.34[医药卫生—肿瘤]