影响Ⅲ期结直肠癌预后的相关因素分析

doi:10.3881/j.issn.1000-503X.2015.05.010

Acta Academiae Medicinae Sinica

Acta Academiae Medicinae Sinica ›› 2015, Vol. 37 ›› Issue (5): 549-556.doi: 10.3881/j.issn.1000-503X.2015.05.010

• Orginal Article • Previous Articles Next Articles

Prognostic Factors of Stage Ⅲ Colorectal Cancer in 433 Patients

De-cong SUN, Hui MAO, Zhi-kuan WANG, Yan SHI, Guang-hai DAI()

Second Department of Oncology,Chinese PLA General Hospital,Beijing 100853,China

Received:2014-10-16 Online:2015-10-15 Published:2015-10-31

Abstract

Abstract:

Objective To summarize the prognostic factors of stage Ⅲ colorectal cancer. Methods The clinical data of 433 patients with stage Ⅲ colorectal cancer who were admitted to our hospital from January 2005 to December 2008 for radical surgery and adjuvant chemotherapy were retrospectively analyzed. Relationship of their clinicopathologic features and treatment with the prognosis were analyzed. Results Of these 433 stage Ⅲ patients,the mean disease-free survival was (72.37±2.11) months and mean overall survival was (79.91±2.02) months;however,the median survival times were not reached. The 1-,3-,and 5-year disease-free survival rate were 86.8%,77.9%,and 57.0% and the overall survival rate were 91.5%,75.1%,and 63.3%. Multivariate COX regression analysis displayed that intestine obstruction before surgery,complications after surgery,tumor location,positive surgical margin,neural cell infiltration,vessel cancer embolus,TNM stage,lymph node ratio,adjuvant chemotherapy regimens,and chemotherapy duration were the independent factors affecting disease-free and overall survivals in patients with stage Ⅲ colorectal cancer. The efficacies of FOLFOX and XELOX regimens were significantly correlated with patient’s age,complications,tumor location,and chemotherapy duration. Conclusions Complications,tumor location,TNM stage,and positive surgical margin are the independent prognostic factors of stage Ⅲ colorectal cancer. FOLFOX and XELOX regimen can remarkably improve prognosis,and a longer duration of chemotherapy can achieve better survival.

Key words: stage Ⅲ colorectal cancer, clinicalpathologic characters, adjuvant chemotherapy, prognosis

CLC Number:

R735.3

De-cong SUN, Hui MAO, Zhi-kuan WANG, Yan SHI, Guang-hai DAI. Prognostic Factors of Stage Ⅲ Colorectal Cancer in 433 Patients[J].Acta Academiae Medicinae Sinica, 2015, 37(5): 549-556.

Figures/Tables 4

Table 1

Univariate analysis on the clinicopathologic features in 433 stage Ⅲ CRC cases"

因素Factor	n	DFS			OS
因素Factor	n	%	χ²	P	%	χ²	P
性别Gender			1.973	0.170		2.281	0.131
男Male	224	51.2			59.0
女Female	189	58.2			66.7
年龄Age			0.657	0.418		2.462	0.117
<55岁	166	56.0			66.3
≥55岁	267	53.2			59.9
糖尿病Diabetes			0.057	0.811		0.679	0.410
否No	389	54.5			63.0
是Yes	44	52.3			56.8
术前肠梗阻Intestine obstruction			11.613	0.001		7.506	0.006
否No	356	57.9			65.2
是Yes	77	37.7			49.4
术后并发症Complications			9.373	0.002		4.406	0.036
否No	388	56.7			63.9
是Yes	45	33.3			48.9
肿瘤部位 Tumor location			9.063	0.003		5.534	0.019
近侧Proximal	98	43.0			54.1
远侧Distal	335	57.3			64.7
低分化 Poor differentiation			9.093	0.003		16.476	0.000
否No	274	59.9			69.7
是Yes	159	44.7			49.7
因素Factor	n	DFS			OS
因素Factor	n	%	χ²	P	%	χ²	P
含有印戒细胞Signet ring cell cancer involved			6.354	0.012		7.614	0.006
否No	421	55.3			63.4
是Yes	12	16.7			25.0
切缘阳性 Positive surgical margin			9.275	0.002		8.782	0.003
否No	392	56.4			64.3
是Yes	41	34.1			43.9
脉管癌栓 Cancer embolus			8.663	0.003		4.638	0.031
否No	335	57.3			64.5
是Yes	98	43.9			55.1
神经浸润 Neural invasion			5.414	0.020		6.080	0.014
否No	415	55.2			63.4
是Yes	18	33.3			38.9
肿瘤直径 Tumor diameter			0.012	0.914		0.031	0.861
≤4.5 cm	239	54.0			61.9
>4.5 cm	194	54.6			62.9
TNM分期TNM stage			38.936	0.000		41.250	0.000
ⅢA	29	82.8			89.7
ⅢB	242	62.8			71.1
ⅢC	162	36.4			44.4
受检淋巴结Examined lymph nodes			12.543	0.000		7.297	0.006
<12	268	27.8			57.6
≥12	165	64.8			70.3
淋巴转移比率Lymph node ratio			12.291	0.000		9.738	0.002
≤0.38	257	61.1			68.1
>0.38	176	44.3			54.0
辅助化疗方案Adjuvant chemotherapy regimen			23.927	0.000		13.247	0.001
XELODA	60	30.0			45.0
XELOX	117	53.0			62.4
FOLFOX	255	60.5			66.4
辅助化疗时间(月)Adjuvant chemotherapy duration(month)			16.731	0.000		28.360	0.000
≤2	142	43.3			45.8
2-4	112	54.5			66.1
4-6	179	63.7			73.2

Table 1

Fig 1

Table 2

Table 3

References 16

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因素 Factors	DFS				OS
因素 Factors	Wald	P	HR	95.0% CI	Wald	P	HR	95.0% CI
术前肠梗阻Obstruction	3.914	0.048	1.424	1.003-2.021	-	-	-	-
术后并发症Complications	9.637	0.002	1.941	1.277-2.951	4.994	0.025	1.715	1.072-2.745
肿瘤部位Tumor location	9.023	0.003	1.609	1.441-1.842	30.958	0.000	1.448	1.044-2.008
TNM分期 TNM stage	30.337	0.000	2.083	1.604-2.704	10.326	0.001	2.299	1.718-3.078
LNR	18.792	0.000	0.498	0.354-0.683	4.626	0.031	0.579	0.411-0.817
切缘阳性Positive margin	5.830	0.016	1.685	1.103-2.572	5.862	0.015	1.604	1.022-2.520
神经浸润Neural invasion	9.362	0.002	2.568	1.403-4.697	12.440	0.000	2.213	1.163-4.211
脉管癌栓Cancer embolus	20.009	0.000	2.074	1.507-2.856	6.201	0.028	1.894	1.324-2.708
化疗方案Chemotherapy	10.263	0.006			3.638	0.045
XELOX vs.XELODA	3.975	0.046	0.648	0.423-0.993	6.110	0.013	0.628	0.389-1.014
FOLFOX vs. XELODA	10.222	0.001	0.533	0.363-0.784	6.145	0.013	0.588	0.383-0.905
化疗持续时间Duration	7.303	0.007	0.659	0.659-0.488	5.117	0.024	0.654	0.467-0.916

项目 Item		辅助化疗Adjuvant chemotherapy[n(%)]		χ²	P
项目 Item		XELOX/FOLFOX	XELODA	χ²	P
性别Gender	男Male	221 (86.5)	33 (13.5)	0.052	0.820
性别Gender	女Female	162 (85.7)	27 (14.3)
年龄Age	平均Mean	58.18	63.25	t=2.841^a	0.005
术后并发症 Complications	否No	346 (92.8)	42 (70.0)	28.754	0.000
术后并发症 Complications	是Yes	27 ( 7.2)	18 (30.0)
肿瘤部位 Tumor location	近侧Proximal	76 (20.4)	22 (36.7)	7.834	0.008
肿瘤部位 Tumor location	远侧Distal	297(79.6)	38 (63.3)
低分化 Poor differentiation	否No	234 (62.7)	40 (66.7)	0.344	0.665
低分化 Poor differentiation	是Yes	139 (37.3)	20 (33.3)
TNM分期TNM stage	ⅢA	25 ( 6.7)	4( 6.7)	0.559	0.756
	ⅢB	211 (56.6)	31 (51.7)
	ⅢC	137 (36.7)	25 (41.7)
辅助化疗持续时间(月) Duration(month)	0-4	218 (58.4)	36 (60.0)	8.886	0.012
辅助化疗持续时间(月) Duration(month)	4-6	155 (41.6)	24 (40.0)

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