Afolabi Hafeez, Salleh Salzihan Md, Zakaria Zaidi, Ch'ng Ewe Seng, Mohd Nafi Siti Norasikin, Abdul Aziz Ahmad Aizat Bin, Al-Mhanna Sameer Badri, Wada Yusuf, Abdulrahman Abdulwali Sabo
Department of General Surgery, School of Medical Sciences, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia USM, Kubang Kerian 16150, Kelantan, Malaysia.
Department of Pathology, School of Medical Sciences, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia USM, Kubang Kerian 16150, Kelantan, Malaysia.
Healthcare (Basel). 2022 Sep 5;10(9):1693. doi: 10.3390/healthcare10091693.
Colorectal carcinoma (CRC) is rising exponentially in Asia, representing 11% of cancer worldwide. This study analysed the influence of CRC on patients’ life expectancy (survival and prognosis factors) via clinicopathology data and comorbidity status of CRC patients. Methodology: A retrospective study performed in HUSM using clinical data from the Surgery unit from 2015 to 2020. The demographic and pertinent clinical data were retrieved for preliminary analyses (data cleansing and exploration). Demographics and pathological characteristics were illustrated using descriptive analysis; 5-year survival rates were calculated using Kaplan−Meier methods; potential prognostic variables were analysed using simple and multivariate logistic regression analysis conducted via the Cox proportional hazards model, while the Charlson Comorbidity Scale was used to categorize patients’ disease status. Results: Of a total of 114 CRC patients, two-thirds (89.5%) were from Malay tribes, while Indian and Chinese had 5.3% each. The 50−69.9 years were the most affected group (45.6%). Overall, 40.4% were smokers (majorly male (95.7%)), 14.0% ex-smokers, and 45.6% non-smokers (p-value = 0.001). The Kaplan−Meier overall 5-year median survival time was 62.5%. From the outcomes, patients who were male and >70 years had metastasis present, who presented with per rectal bleeding and were classified as Duke C; and who has tumour in the rectum had the lowest survival rate. Regarding the prognosis factors investigated, “Gender” (adjusted hazard ratio (HR): 2.62; 95% CI: 1.56−7.81, p-value = 0.040), “Presence of metastases” (HR: 3.76; 95% CI: 1.89−7.32, p-value = 0.010), “Metastasis site: Liver” (HR: 5.04; 95% CI: 1.71−19.05, p-value = 0.039), “Lymphovascular permeation” (HR: 2.94; 95% CI: 1.99−5.92, p-value = 0.021), and “CEA-level” (HR: 2.43; 95% CI: 1.49−5.80, p-value = 0.001) remained significant in the final model for multiple Cox proportional hazard regression analyses. There was a significant mean association between tumour grades and the patient’s comorbidity status. Conclusions: Histopathological factors (gender, metastases presence, site of metastases, CEA level, and lymphovascular permeation) showed the best prognosis-predicting factors in CRC.
结直肠癌（CRC）在亚洲呈指数级增长，占全球癌症的11%。本研究通过结直肠癌患者的临床病理数据和合并症状态，分析了CRC对患者预期寿命（生存和预后因素）的影响。方法：在胡先汉大学医学中心（HUSM）进行一项回顾性研究，使用2015年至2020年外科的临床数据。检索人口统计学和相关临床数据进行初步分析（数据清理和探索）。使用描述性分析说明人口统计学和病理特征；使用Kaplan-Meier方法计算5年生存率；通过Cox比例风险模型进行简单和多变量逻辑回归分析，分析潜在的预后变量，同时使用Charlson合并症量表对患者的疾病状态进行分类。结果：在总共114例CRC患者中，三分之二（89.5%）来自马来族，印度人和中国人各占5.3%。50 - 69.9岁是受影响最大的群体（45.6%）。总体而言，40.4%为吸烟者（主要为男性（95.7%）），14.0%为既往吸烟者，45.6%为非吸烟者（p值 = 0.001）。Kaplan-Meier总体5年中位生存时间为62.5%。从结果来看，男性且年龄>70岁、有转移、出现直肠出血且分类为杜克C期；以及直肠有肿瘤的患者生存率最低。关于所研究的预后因素，在多重Cox比例风险回归分析的最终模型中，“性别”（调整后风险比（HR）：2.62；95%置信区间：1.56 - 7.81，p值 = 0.040）、“转移的存在”（HR：3.76；95%置信区间：1.89 - 7.32，p值 = 0.010）、“转移部位：肝脏”（HR：5.04；95%置信区间：1.71 - 19.05，p值 = 0.039）、“淋巴管浸润”（HR：2.94；95%置信区间：1.99 - 5.92，p值 = 0.021）和“癌胚抗原水平”（HR：2.43；95%置信区间：1.49 - 5.80，p值 = 0.001）仍然具有显著性。肿瘤分级与患者的合并症状态之间存在显著的平均关联。结论：组织病理学因素（性别、转移的存在、转移部位癌胚抗原水平和淋巴管浸润）显示出结直肠癌中最佳的预后预测因素。
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