50岁以下直肠癌患者临床病理特征及预后的性别差异分析  

Gender differences in clinicopathological characteristics and prognosis of rectal cancer patients under 50 years old

作　　者：田名伟 杨鋆 冯哲文 顾晓哲 李东明 李俊[1] 姚宏伟[1] 白志刚[1] 杨盈赤[1] 张忠涛[1] Tian Mingwei;Yang Yun;Feng Zhewen;Gu Xiaozhe;Li Dongming;Li Jun;Yao Hongwei;Bai Zhigang;Yang Yingchi;Zhang Zhongtao(Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Gastric and Colorectal Surgery,the First Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]首都医科大学附属北京友谊医院普外科,北京100050 [2]吉林大学第一医院胃结直肠外科,长春130021

出　　处：《国际外科学杂志》2022年第11期739-745,共7页International Journal of Surgery

基　　金：国家科技支撑计划课题(2015BAI13B09);国家重点研发计划资助(2017YFC0110904);首都卫生发展科研专项(2022-2-1112);北京市属医院科研培育项目(PX2022002);首都医科大学附属北京友谊医院科研启动基金资助项目(YYQDKT2019-21)。

摘　　要：目的探究年轻(50岁以下)直肠癌患者临床病理特征及预后是否存在性别差异,分析影响年轻直肠癌患者预后的危险因素。方法回顾性收集2015年1月—2020年12月首都医科大学附属北京友谊医院收治的85例年轻直肠癌患者的病历资料,根据性别分为男性组(n=50)与女性组(n=35),年龄(43.67±5.50)岁,年龄范围26~50岁。主要观察指标:患者的性别、无病生存期及总生存期。次要观察指标:家族史、体重指数(BMI)、临床分期、是否贫血、女性患者是否绝经、女性患者是否口服雌孕激素、原发灶部位、是否行新辅助治疗、病理分期、是否伴有脉管神经侵犯以及是否行术后辅助治疗。正态分布的计量资料采用均数±标准差(±s)表示,组间比较采用t检验;计数资料采用例数和百分率(%)表示,组间比较采用χ2检验或Fisher精确概率法。采用Kaplan-Meier法绘制生存曲线、Log-rank检验生存率差异。将单因素分析中有统计学意义的因素纳入COX比例风险回归模型进行多因素分析以筛选影响总生存期的独立危险因素。结果年轻女性直肠癌患者与男性患者相比有较高的比例在术前确诊为贫血(42.9%比22.0%,P=0.040)。女性患者1、3、5年总生存率分别为94.3%、80.0%、68.6%,男性患者分别为98.0%、90.0%、90.0%。女性患者中位无病生存期为31.6个月,男性患者为34.4个月。多因素分析显示,女性(HR=3.799,95%CI:1.312~11.002,P=0.014)、BMI(HR=0.846,95%CI:0.724~0.989,P=0.036)是影响年轻直肠癌患者预后的独立危险因素。结论年轻女性患者与男性患者相比有更差的预后。女性、BMI为年轻直肠癌患者预后的独立危险因素,性别需成为年轻直肠癌患者群体的重点研究对象。Objective To explore whether there are gender differences in clinical and pathological characteristics and prognosis of young patients with rectal cancer(under 50 years old),and to analyze the risk factors affecting the prognosis of young patients with rectal cancer.Methods The medical records of 85 young rectal cancer patients admitted to Beijing Friendship Hospital Affiliated to Capital Medical University from January 2015 to December 2020 were retrospectively collected.According to gender,they were divided into male group(n=50)and female group(n=35).The age was(43.67±5.50)years old,ranging from 26 to 50 years old.Primary outcome measures were sex,disease-free survival,and overall survival.Secondary outcomes were family history,body mass index(BMI),clinical stage,anemia,whether the female patient was menopausal,whether the female patient took oral estrogen,the location of the primary lesion,whether neoadjuvant therapy was performed,pathological stage,whether accompanied with vascular nerve invasion,and whether postoperative adjuvant therapy was performed.R4.0.2 software was used for statistical analysis.The measurement data with normal distribution in the collected data were expressed as mean±standard deviation(±s),and the comparison between groups was analyzed by t test.Count data were expressed as constituent ratio,and analyzed using the chi-square test or Fisher′s exact test.The survival curve was drawn by Kaplan-Meier method,and the difference in survival rate was tested by Log-rank test.Factors with statistical significance in univariate analysis were included in COX proportional regression model for multivariate analysis to screen independent risk factors affecting overall survival.Results Compared with male patients,a higher proportion of young female patients with rectal cancer were diagnosed with anemia before surgery(42.9%vs 22.0%,P=0.040).The 1-year,3-year and 5-year overall survival rates were 94.3%,80.0%and 68.6%in young female patients,and 98.0%,90.0%and 90.0%in young male patients,respective

关 键 词：性别因素 直肠肿瘤 发病年龄 贫血 

分 类 号：R735.37[医药卫生—肿瘤]