围手术期外周血 SEPT9水平变化对结直肠癌根治术预后的影响  

Effect of perioperative SEPT9 level on prognosis after radical resection of colorectal cancer

作　　者：曹迪 于国志[1] 任春成 王敏[1] 王凯[1] 安宁[1] 石岩 张玉茹[1] Cao Di;Yu Guozhi;Ren Chuncheng;Wang Min;Wang Kai;An Ning;Shi Yan;Zhang Yuru(Department of Anus&Intestine Surgery,Beijing Hospital of Coloproctology,Beijing Erlonglu Hospital,Beijing 100120,China)

机构地区：[1]北京市肛肠医院(北京市二龙路医院)肛肠外科,北京100120

出　　处：《国际外科学杂志》2023年第9期605-611,F0004,共8页International Journal of Surgery

基　　金：北京市科技计划课题资助项目(Z18110000161)。

摘　　要：目的分析结直肠癌患者围手术期外周血SEPT9水平变化对远期预后的影响。方法回顾性分析北京市肛肠医院(北京市二龙路医院)肛肠外科2017年1月—2022年12月手术治疗的334例结直肠癌患者资料, 其中男性197例, 女性137例, 年龄29~83岁, 平均(62.8±10.7)岁。术前SEPT9阳性患者为阳性组(n=241), 术前SEPT9阴性患者为阴性组(n=93)。在阳性组患者中有169例在接受手术术后1周SEPT9转阴(转阴组), 另外有72例未转阴(未转阴组)。对患者的临床一般资料进行单因素及多因素分析, 筛选出影响结直肠癌患者术后远期预后的危险因素。生存曲线采用Kaplan-Meier法计算, 采用Log-rank检验比较两组之间生存率的差异。结果患者总体中位生存时间为67个月, 术后1、3、5年总体生存率为91.9%、70.9%、57.1%。多因素分析结果表明, 是否淋巴结转移、TNM分期、术前SEPT9是否阳性是影响结直肠癌患者远期预后的独立危险因素(P=0.004、<0.001、0.041), 而对于术前SEPT9阳性的患者, 肿瘤TNM分期及术后SEPT9是否转阴是影响预后的独立危险因素(P=0.026、0.001)。阳性组和阴性组患者的中位生存时间分别为63个月和71个月, 术后1、3、5年生存率分别为90.4%、67.0%、55.0%和95.7%、79.1%、64.6%(P=0.007)。术后未转阴组和术后转阴组患者的中位生存时间分别为45个月和62个月, 术后1年、3年、5年生存率分别为83.2%、60.5%、48.1%和93.5%、72.9%、63.5%(P<0.001)。结论围手术期SEPT9水平与结直肠癌患者术后远期预后相关, 术前SEPT9阴性的患者预后好于SEPT9阳性的患者。术前阳性患者术后未转阴往往提示肿瘤预后不佳。Objective To analyze the effect of perioperative SEPT9 level in peripheral blood on long-term prognosis of patients with colorectal tumors.Methods Retrospectively analyzed the data of 334 patients with colorectal cancer admitted to the Department of Anus&Intestine Surgery from January 2017 to December 2022,including 197 male patients and 137 female patients,aged 29 to 83(62.8±10.7)years.Positive group was consisted of 241 patients with positive SEPT9 before surgery,while negative group was consisted of 93 patients with negative SEPT9 before surgery.Among the positive group,169 cases turned negative for SEPT9 on the one week after surgery(transnegative group),and another 72 cases did not turn negative(non negative group).Univariate and multivariate analysis of clinical general data were carried out to screen out the risk factors affecting the long-term prognosis of colorectal cancer patients after surgery.The survival curve was calculated by Kaplan-Meier method,and the Log-rank test was used to compare the difference in survival rate between groups.Results All patients′overall median survival time was 67 months,and the 1,3 and 5 years overall survival rate was 91.9%,70.9%and 57.1%.The results of multi-factor analysis showed that whether the tumor had lymph node metastasis,TNM stage,and preoperative SEPT9 methylation status were independent risk factors affecting the long-term prognosis of colorectal cancer(P=0.004,<0.001,0.041),while for patients with preoperative SEPT9 positive,TNM stage of tumor and whether SEPT9 turned negative after surgery were independent risk factors for prognosis(P=0.026,0.001).The median survival time of patients in positive group and negative group was 63 months and 71 months,respectively.The 1,3 and 5 year survival rates after surgery were 90.4%,67.0%,55.0%and 95.7%,79.1%and 64.6%,respectively(P=0.007).The median survival time of the patients in the transnegative group and nonnegative group was 45 months and 62 months,respectively.The 1,3 and 5-year survival rates were 83.2%,60.5%,48

关 键 词：结直肠肿瘤 甲基化 预后 

分 类 号：R735.34[医药卫生—肿瘤]