术前合并症、全身炎症反应与结直肠癌根治性切除术后患者生存的关系。

Relationship between preoperative comorbidity, systemic inflammatory response, and survival in patients undergoing curative resection for colorectal cancer.

机构信息

University Department of Surgery, Faculty of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, Scotland, UK.

出版信息

Ann Surg Oncol. 2011 Apr;18(4):997-1005. doi: 10.1245/s10434-010-1410-8. Epub 2010 Nov 2.

DOI:10.1245/s10434-010-1410-8

PMID:21042941

Abstract

BACKGROUND

Besides tumor characteristics, colorectal cancer (CRC) outcomes are also determined by host factors, in particular the systemic inflammatory response. The basis of this relationship with survival is not known; however, systemic inflammation may reflect comorbidity. The present study examines relationships between host factors (including age, comorbidity, deprivation, and systemic inflammation) and survival in CRC.

METHODS

A total of 302 patients underwent curative elective CRC resection between 1997 and 2005. Data was collected on patient comorbidity (Charlson Comorbidity Index [CCI], Lee Cardiac Risk Index [LCRI], National Institute on Aging and National Cancer Institute Comorbidity Index [NIA/NCI], and Adult Comorbidity Evaluation-27 [ACE-27]), systemic inflammatory response (Glasgow Prognostic Score [mGPS]), deprivation [Carstairs Deprivation Index], body mass index, and smoking status.

RESULTS

For cancer-specific survival, age (P = 0.047), tumor, node, metastasis system stage (P < 0.001), high-risk Petersen Index (P < 0.001), LCRI (P = 0.021), and mGPS (P < 0.001) were independent factors by multivariate analysis. For overall survival, age (P < 0.001), tumor, node, metastasis system stage (P = 0.001), high-risk Petersen Index (P = 0.002), postoperative infective complications (P = 0.002), ACE-27 (P = 0.008), and mGPS (P < 0.001) were independent factors. Older age related to increasing comorbidity (ACE-27, CCI, LCRI [P < 0.005]) and increased mGPS (P < 0.005). Smoking and deprivation related to increasing comorbidity (P < 0.05). The mGPS was associated with high comorbidity burden assessed with ACE-27 (P = 0.065), CCI (P = 0.016), LCRI (P = 0.095), and NIA/NCI (P = 0.084).

CONCLUSIONS

Comorbidity does not fully explain the relationship between the mGPS and cancer-specific survival in CRC patients. Furthermore, comorbidity, in particular that measured by the LCRI, is an important independent indicator of cancer survival.

摘要

背景

除了肿瘤特征外，结直肠癌（CRC）的预后还取决于宿主因素，特别是全身炎症反应。这种与生存相关的关系的基础尚不清楚；然而，全身炎症可能反映合并症。本研究探讨了宿主因素（包括年龄、合并症、贫困和全身炎症）与 CRC 患者生存之间的关系。

方法

本研究共纳入 302 例于 1997 年至 2005 年间接受根治性择期 CRC 切除术的患者。收集患者的合并症数据（Charlson 合并症指数[CCI]、Lee 心脏风险指数[LCRI]、国立衰老研究所和国家癌症研究所合并症指数[NIA/NCI]和成人合并症评估-27[ACE-27]）、全身炎症反应（格拉斯哥预后评分[mGPS]）、贫困（卡斯特斯贫困指数）、体重指数和吸烟状况。

结果

在癌症特异性生存方面，年龄（P=0.047）、肿瘤、淋巴结、转移系统分期（P<0.001）、高危 Petersen 指数（P<0.001）、LCRI（P=0.021）和 mGPS（P<0.001）是多变量分析的独立因素。在总生存方面，年龄（P<0.001）、肿瘤、淋巴结、转移系统分期（P=0.001）、高危 Petersen 指数（P=0.002）、术后感染性并发症（P=0.002）、ACE-27（P=0.008）和 mGPS（P<0.001）是独立因素。年龄越大，合并症越严重（ACE-27、CCI、LCRI[P<0.005]），mGPS 越高（P<0.005）。吸烟和贫困与合并症增多有关（P<0.05）。mGPS 与 ACE-27（P=0.065）、CCI（P=0.016）、LCRI（P=0.095）和 NIA/NCI（P=0.084）评估的高合并症负担相关。