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目的:探讨Ⅰ~Ⅲ期根治术后左半结肠癌(left-sided colon cancer,LCC)与右半结肠癌(right-sided colon cancer,RCC)患者预后的影响因素。方法 :回顾性分析2008年2月—2012年2月在安徽医科大学附属省立医院接受根治术的332例Ⅰ~Ⅲ期结直肠癌(colorectal cancer,CRC)患者的临床资料。应用χ2检验分析原发肿瘤位置与临床病理特征之间的相关性;采用Kaplan-Meier法绘制生存曲线,log-rank法和COX回归模型分别进行CRC患者预后的单因素和多因素分析。结果 :所有患者的5年总生存率为69.9%。LCC与RCC患者5年总生存率的差异有统计学意义(72.6%vs 66.9%,P=0.020)。其中,Ⅲ期LCC患者的5年总生存率高于RCC患者(62.5%vs 52.2%,P=0.018),但Ⅰ、Ⅱ期LCC患者与RCC患者5年总生存率的差异均无统计学意义(P>0.05)。LCC与RCC患者的肿瘤T分期、组织学分类、分化程度、肿瘤最大直径以及血红蛋白、血清白蛋白、血浆纤维蛋白原和血清癌胚抗原水平的差异有统计学意义(P值均<0.05)。单因素分析结果显示,肿瘤部位、T分期、N分期、组织学分类、分化程度、肿瘤最大直径以及血红蛋白、血清白蛋白、血浆纤维蛋白原和血清癌胚抗原水平与5年总生存率有关(P值均<0.05)。多因素分析结果显示,肿瘤N分期、组织学分类、分化程度以及血红蛋白、血清白蛋白、血浆纤维蛋白原和血清癌胚抗原水平是CRC的独立预后因素(P值均<0.05)。结论 :对于Ⅰ~Ⅲ期根治术后CRC患者,肿瘤N分期较高、黏液腺癌/印戒细胞癌、低分化癌、贫血、低白蛋白血症、血浆纤维蛋白原≥4 g/L、血清癌胚抗原≥10 ng/m L提示预后不良。LCC与RCC的的临床病理特征和预后存在差异,但原发肿瘤位置不是独立的预后因素。
Objective: To investigate the influencing factors of prognosis in patients with left-sided colon cancer (LCC) and right-sided colon cancer (RCC) after radical hysterectomy. Methods: The clinical data of 332 patients with stage Ⅰ ~ Ⅲ colorectal cancer (CRC) undergoing radical operation at Provincial Hospital of Anhui Medical University from February 2008 to February 2012 were retrospectively analyzed. Chi-square test was used to analyze the correlation between primary tumor location and clinicopathological features. Kaplan-Meier survival curves, log-rank test and COX regression model were used to analyze the prognosis of CRC patients by single factor and multivariate analysis respectively. Results: The 5-year overall survival of all patients was 69.9%. The 5-year overall survival was significantly different between patients with LCC and those with RCC (72.6% vs 66.9%, P = 0.020). Among them, the 5-year overall survival rate of patients with stage III LCC was significantly higher than that of patients with RCC (62.5% vs 52.2%, P = 0.018). However, there was no significant difference in 5-year overall survival between patients with stage I, II LCC and patients with RCC (P> 0.05). There were significant differences in T stage, histological classification, differentiation degree, maximum tumor diameter, hemoglobin, serum albumin, plasma fibrinogen and serum carcinoembryonic antigen in patients with LCC and RCC (P <0.05). Univariate analysis showed that tumor location, T stage, N stage, histological classification, degree of differentiation, maximum tumor diameter, and hemoglobin, serum albumin, plasma fibrinogen, and serum carcinoembryonic antigen were associated with 5-year overall survival ( P <0.05). Multivariate analysis showed that tumor N stage, histological classification, degree of differentiation and hemoglobin, serum albumin, plasma fibrinogen and serum carcinoembryonic antigen were independent predictors of CRC (all P <0.05). Conclusion: For patients with stage Ⅰ ~ Ⅲ postoperative radical mastectomy, the tumor stage has a higher N stage, mucinous adenocarcinoma / signet ring cell carcinoma, poorly differentiated carcinoma, anemia, hypoalbuminemia, plasma fibrinogen ≥4 g / L, Serum CEA ≥ 10 ng / m L suggests poor prognosis. The clinicopathological features and prognosis of LCC and RCC are different, but the primary tumor location is not an independent prognostic factor.