结直肠癌手术后 5 年生存率的预后因素评估。

Evaluation of prognostic factors for 5 year-survival after surgery for colorectal cancer.

出版信息

Ann Ital Chir. 2020;91:41-48.

Abstract

AIM

The aim of this study was to assess and analyze the prognostic factors for survival in patients undergoing curative surgery for colorectal cancer and to identify new prognostic factors.

METHODS

The prospective study included 301 patients diagnosed with colorectal cancer, stages I-III, undergoing curative surgery. Demographic data, clinical and anamnestic data, laboratory exams, paraclinical examinations, morphological and pathological examination were recorded. The Petersen index was calculated. Tumor necrosis, desmoplasia and mucinous component were assessed. Local inflammatory response was calculated using Klintrup criteria. Patients were followed for five years after surgery.

RESULTS

There were 197 patients (66.4%) who survived and 104 patients (34.6%) who died during the 5-year follow- up period. Multivariate analysis showed that death was mostly associated with patients over 60 years of age (p=0.05). Tumor location within the colon was associated with a better survival than tumor location within the rectum (HR - 0.57; p=0.02). Patients with T>2 had a poor prognosis compared to those with T=<2 (HR - 2.23; p=0.02). Patients with Klintrup score >1 had a better prognosis (HR - 0.20; p <0.001). Patients with venous invasion showed significantly worse prognosis (HR - 2.26; p=0.003). Patients with desmoplasia score 3 had lower death rates than those with score 1 (HR - 0.42; p=0.01).

CONCLUSION

Survival was superior in patients with cancer of the colon. The following parameters had a strong independent prognostic factor for survival: age, stage T>2, venous invasion, mucinous component and desmoplasia.

KEY WORDS

Colorectal cancer, Prognostic factors, Survival.

摘要

目的

本研究旨在评估和分析接受结直肠癌根治性手术患者的生存预后因素，并确定新的预后因素。

方法

前瞻性研究纳入 301 例 I-III 期结直肠癌患者，接受根治性手术。记录患者的人口统计学数据、临床和病史数据、实验室检查、影像学检查、形态学和病理学检查。计算彼得森指数。评估肿瘤坏死、纤维组织增生和黏液成分。根据克林特鲁普标准计算局部炎症反应。患者在手术后随访 5 年。

结果

在 5 年的随访期间，有 197 例（66.4%）患者存活，104 例（34.6%）患者死亡。多因素分析显示，死亡与 60 岁以上患者（p=0.05）关系最为密切。肿瘤位于结肠的患者比肿瘤位于直肠的患者生存预后更好（HR-0.57；p=0.02）。T>2 的患者预后较差，而 T<2 的患者预后较好（HR-2.23；p=0.02）。克林特鲁普评分>1 的患者预后较好（HR-0.20；p<0.001）。有静脉侵犯的患者预后明显较差（HR-2.26；p=0.003）。纤维组织增生评分 3 分的患者死亡率低于评分 1 分的患者（HR-0.42；p=0.01）。