TNM分期与第三腰椎骨骼肌指数联合评分对老年结直肠癌患者预后影响的研究  

The prognostic value of TNM stage and L3-skeletal muscle mass index combined score in elderly patients with colorectal cancer

作　　者：李文彬 陈婉玲 蓝琴芬 钟威 阙志鹏 许东波 Li Wenbin;Chen Wanling;Lan Qinfen;Zhong Wei;Que Zhipeng;Xu Dongbo(Department of Clinical Nutrition,Longyan First Hospital,Fujian Medical University,Longyan 364000,China;Department of Ophthalmology,Longyan First Hospital,Fujian Medical University,Longyan 364000,China;Department of Education,Longyan First Hospital,Fujian Medical University,Longyan 364000,China;Department of Gastrointestinal and Anal Surgery,Longyan First Hospital,Fujian Medical University,Longyan 364000,China)

机构地区：[1]福建医科大学附属龙岩第一医院临床营养科,龙岩364000 [2]福建医科大学附属龙岩第一医院眼科,龙岩364000 [3]福建医科大学附属龙岩第一医院科教科,龙岩364000 [4]福建医科大学附属龙岩第一医院胃肠肛门外科,龙岩364000

出　　处：《中华老年医学杂志》2025年第3期324-329,共6页Chinese Journal of Geriatrics

摘　　要：目的研究肿瘤TNM分期、第三腰椎骨骼肌指数(L3-skeletal muscle mass index combined score,L3SMI)与老年性结直肠癌患者术后总生存期(overall survival,OS)的相关性,并进一步探讨二者联合评分TNM-SMI对结直肠癌患者预后的预测价值。方法回顾性分析2018年1月1日至2019年1月31日于福建医科大学附属龙岩第一医院首次确诊结直肠癌的老年患者的临床资料,比较不同TNM分期、L3SMI水平患者的基线资料,将可能影响患者预后的相关因素进行Cox比例风险回归分析,确定影响预后的独立危险因素。使用Kaplan-Meier法绘制两组的生存曲线,组间生存比较采用Log-rank检验。通过绘制受试者工作特征(receiver operating characteristic,ROC)曲线,计算曲线下面积(area under the curve,AUC)来比较预测效能。结果共纳入符合标准的患者128例,年龄65~88(73.96±6.20)岁,其中男性82例。单因素及多因素Cox回归分析结果显示,肿瘤TNM分期(HR=3.944,95%CI:1.519~10.237,P<0.05)、L3SMI(HR=3.194,95%CI:1.222~8.349,P<0.05)是老年结直肠癌患者OS的独立危险因素;通过Kaplan-Meier法绘制生存曲线,结果显示TNM(Ⅲ、Ⅳ)组患者的5年总生存率(OS率)比TNM(Ⅰ、Ⅱ)组低(58.8%比88.9%,P<0.001),低L3SMI组患者的5年总生存率(OS率)比高L3SMI组低(51.0%比88.3%,P<0.001)。通过联合评分TNM-SMI对老年结直肠癌患者进行风险分层,得分越高的患者5年OS率越差。ROC曲线分析结果显示L3SMI、TNM分期和TNM-SMI评分的AUC分别为0.729、0.695、0.800。结论肿瘤TNM分期与L3SMI是影响结直肠癌术后OS的独立危险因素。肿瘤TNM分期与L3SMI两种指标联合的TNM-SMI评分相较于单一指标能更准确地预测预后,TNM-SMI评分越高,患者预后越差。肿瘤TNM分期与L3SMI联合应用可提高对结直肠癌术后OS的预测效能。ObjectiveWe study the prognostic value of TNM stage and L3-skeletal muscle mass index in overall survival(OS)in elderly patients with colorectal cancer after surgery.Furthermore,investigate the prognostic value of combined scoring system(TNM-SMI score)in patients with colorectal cancer.MethodsFrom January 1,2018 to January 31,2019,the clinical data of elderly patients who were diagnosed with colorectal cancer for the first time in Longyan First Hospital,Fujian Medical University were retrospectively analyzed.The baseline data were compared in patients with different TNM stage and L3SMI.The relevant factors that might affect the prognosis of the patients were analyzed to determine the independent risk factors in cox regression analyses.Survival curves were plotted by using the Kaplan-Meier method,and Log-rank test was used to compare Overall Survival.Predictive efficacy was compared by plotting(ROC)curve and calculating the area under the curve(AUC).ResultsA total of 128 eligible patients aged 65-88(73.96±6.20)years were enrolled.Among them,82 were male.Univariate and multifactorial cox regression analyses showed that TNM stage(HR=3.944,95%CI:1.519-10.237,P<0.05)and L3SMI(HR=3.194,95%CI:1.222-8.349,P<0.05)were the independent risk factors for OS in elderly colorectal cancer patients;Survival curves plotted by Kaplan-Meier method showed that the 5-year survival rate(OS rate)of patients in TNM(ⅢandⅣ)group was lower than in TNM(ⅠandⅡ)group(58.8%vs.88.9%,P<0.001),and the 5-year survival rate(OS rate)of patients in low L3SMI group was lower than in high L3SMI group(51.0%vs.88.3%,P<0.001);Elderly colorectal patients were risk stratified by TNM-SMI score,the patients with higher score had worse 5-year OS rate;The AUC of L3SMI,TNM stage,and TNM-SMI score are 0.729,0.695,and 0.800.ConclusionsThe TNM stage and L3SMI are independent risk factors of OS after colorectal cancer surgery;TNM-SMI score,which combines TNM stage and L3SMI,can predict prognosis more efficiency compare to single-factor.The higher TNM-SMI scor

关 键 词：肿瘤分期 结直肠肿瘤 预测 

分 类 号：R73[医药卫生—肿瘤]