摘要
目的比较青年与老年结直肠癌病人临床病理学特点的差异并探讨影响青年结直肠癌病人预后的因素。方法回顾性分析2012年1月至2016年12月中山大学附属第六医院收治的青年(诊断年龄<40岁,398例)和老年(诊断年龄60~70岁,398例)结直肠癌病人临床病理资料的差异。通过术后随访了解病人的生存情况,随访截止时间为2017年12月。采用Kaplan-Meier法绘制生存曲线并计算存活率,采用Log-rank检验与Cox回归模型进行预后分析。结果青年组病人肿瘤家族史比例高(P<0.001),TNM分期以Ⅲ、Ⅳ期为主(P=0.015),更倾向接受新辅助治疗(P<0.001),血清白蛋白高(P<0.001),术前贫血比例高(P=0.017),而术前癌胚抗原(CEA)阳性率及体重指数(BMI)较低(P值均<0.001)。术后病理,青年组病人肿瘤体积较大(P<0.001),浸润型肿瘤比例高(P=0.023),分化程度较低(P=0.003)且黏液腺癌的比例大(P<0.001)。青年组与老年组的3年存活率分别为85.5%与85.6%。单因素及多因素预后分析均显示青年组与老年组总体存活率差异无统计学意义。青年结直肠癌病人预后多因素分析显示,TNM分期Ⅳ期(HR=10.85,95%CI 4.698~25.050,P<0.001)及脉管癌栓阳性(HR=4.283,95%CI 1.956~9.378,P<0.001)是影响青年结直肠癌病人预后的独立危险因素。结论青年与老年结直肠癌病人的临床及病理学特征存在差异,但总体存活率差异无统计学意义。TNM分期Ⅳ期及脉管癌栓阳性是影响青年结直肠癌病人预后的独立危险因素。
Objective To investigate the difference of clinicopathologic characteristics between young and old colorectal cancer patients and the prognosis of young patients.Methods Young(≤40 years old,n=398)and old(60-70 years old,n=398)patients diagnosed as colorectal cancer from January 2012 to December 2016 in the Sixth Affiliated Hospital of Sun Yat-sen University were included in the retrospective study and their clinicopathologic characteristics were compared.Survival data were obtained by follow-up examinations and the last time of follow-up was December 2017.Survival rate was calculated and the survival curve was drew by Kaplan-Meier.Log-rank test was conducted to compare the difference of survival rate and Cox regression model was used to analyze the risk factors of prognosis.Results Young colorectal cancer was associated with higher proportion of family history(P〈0.001),ⅢandⅣstages of TNM(P=0.015),neoadjuvant therapy(P〈0.001),anemia(P=0.017)and positive rate of preoperative CEA(P〈0.001),as well as lower albumin(P〈0.001)and BMI(P〈0.001).Postoperative pathology showed that larger volume(P〈0.001),more invasive behavior(P=0.023),poorer differentiation(P=0.003)and higher proportion of mucinous adenocarcinoma were found in young colorectal cancer.The three-years survival rate were 85.5%and 85.6%in the young and old group respectively.Univariable and multivariable prognostic analysis showed that there was no significant difference in overall survival between groups.Multivariable analysis of prognosis in young patients with colorectal cancer showed that IV stgage(HR,10.85;95%CI,4.698-25.050;P〈0.001)and lymphovascular invasion(HR,4.283;95%CI,1.956-9.378;P〈0.001)were independent risk factors of prognosis.Conclusion The clinicopathologic characteristics are different between the young and old colorectal cancer,while the overall survival rate is not significantly different.IV stage and lymphovascular invasion are independent risk factors of prognosis in young patients with colorectal cancer.
作者
黄群生
程克力
何晓生
陈平
熊家庆
吴小剑
兰平
练磊
HUANG Qun-sheng;CHENG Ke-li;HE Xiao-sheng(Department of Colorectal Surgery,tile Sixth Affiliated Hospital,Sun Yat-sen Universit,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases,Guangzhou 510655,China;不详)
出处
《中国实用外科杂志》
CSCD
北大核心
2018年第6期666-671,共6页
Chinese Journal of Practical Surgery
基金
国家自然科学基金面上项目(No.81570596,No.81770557)
中山大学重大项目和前沿新兴交叉学科培育资助计划(No.17ykjc20)
关键词
结直肠癌
青年病人
临床病理学特征
预后
colorectal cancer
young patient
clinicopathologic characteristics
prognosis
