回顾性队列分析术前梗阻对结直肠癌生存预后的影响  

Retrospective cohort study on prognosis impact of preoperative obstruction in colorectal cancer

作　　者：宋建宁[1] 白志刚[1] 李俊[1] 杨鋆 吴国聪[1] 姚宏伟[1] 王今[1] 金岚[1] 汪栋[1] 张忠涛[1] 杨盈赤[1] Song Jianning;Bai Zhigang;Li Jun;Yang Yun;Wu Guocong;Yao Hongwei;Wang Jin;Jin Lan;Wang Dong;Zhang Zhongtao;Yang Yingchi(Department of General Surgery,Beijing Friendship Hospital,Capital Medical University National Clinical Research Center for Digestive Disease,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院普外科,国家消化系统疾病中心普外分中心,北京100050

出　　处：《国际外科学杂志》2022年第5期327-332,I0007,共7页International Journal of Surgery

摘　　要：目的探讨术前梗阻对结直肠癌患者生存预后的影响以及可能的机制。方法选取2003年1月—2014年12月就诊于首都医科大学附属友谊医院普外科的结直肠癌患者1574例,其中194例发生术前肠梗阻。首先对194例梗阻性结直肠癌患者进行临床特点描述,然后对1574例结直肠癌队列通过COX多因素回归分析,分析术前梗阻是否为总生存期短的独立危险因素;最后采用倾向评分匹配法,对梗阻和非梗阻病例进行匹配,匹配可能同时影响梗阻和预后的混杂因素,然后分析总生存期差异。结果194例梗阻性结直肠癌患者中,肿瘤位于左半和右半分别为60.3%(117例)和37.1%(72例),55.7%(112例)的患者肿瘤直径大于5 cm,中位生存时间39.7月,95%CI为(28.3,60.4)。多因素COX分析,调整相关混杂因素,发现术前是否梗阻是不良预后的独立危险因素(HR=1.41,95%CI:1.01~1.97)。经过倾向评分匹配梗阻组和非梗阻组分别纳入140例和560例患者,两组的中位生存时间分别为42.4、116.3个月(P<0.001),梗阻患者总生存期显著差于非梗阻患者。结论术前梗阻是结直肠癌不良预后的独立危险因素,可能是因为梗阻性结直肠癌手术难度大、根治率低所致。Objective To investigate the effect of obstruction on the prognosis and possible mechanisms in colorectal cancer patients.Methods Among 1574 cases of colorectal cancer who were treated in Beijing Friendship Hospital,Capital Medical University from January 2003 to December.2014,194 cases had preoperative intestinal obstruction.Firstly,described the clinical characteristics of 194 patients with obstruction,then COX multivariate regression analysis was performed on the 1574 colorectal cancer cohort to confirm whether the preoperative obstruction was independent predictor for the overall survival.Finally,propensity score matching method was used to match obstruction and non-obstruction cases,then compared overall survival difference.Results In 194 cases of obstructive colorectal cancer,60.3%and 37.1%of the tumors were located in the left and right respectively.The 55.7%of the patients had tumors larger than 5 cm in diameter,the median survival time was 39.7 months(95%CI:28.3-60.4).Multivariate COX analysis,after adjusted for related confounding factors,found that preoperative obstruction is still an independent risk factor for poor prognosis(HR=1.41,95%CI:1.01-1.97).After propensity score matching,140 and 560 patients were included in the obstructive group and the non-obstructive group.The two groups were more balanced in most baseline characteristics.The median survival time of the two groups was 42.4 and 116.3 months(P<0.001),the overall survival of obstructive patients was significantly worse than that of non-obstructive patients.Conclusions Preoperative obstruction is an independent risk factor for poor prognosis of colorectal cancer.This may be due to the difficulty of surgery and low radical cure rate for obstructive colorectal cancer.

关 键 词：肠梗阻 结直肠肿瘤 预后 回顾性研究 队列研究 

分 类 号：R735.3[医药卫生—肿瘤]