370例结直肠癌患者预后影响因素及预后预测分析

目的探讨结直肠癌患者的预后影响因素并建立模型预测预后。方法选择病理诊断的结直肠癌原发病例370例，收集临床病理因素并进行随访。采用Kaplan—Meier法计算生存率，Log—rank检验进行单因素分析，比例风险回归模型（cox模型）进行多因素分析，计算预后指数（PI），cox模型比例风险假定（PH假定）的检验采用对数累积风险函数图法。结果结直肠癌患者1、3、5年生存率分别为90．5％、78．3％和76．5％；淋巴转移、Duckes分期、治疗方式进入结直肠癌预后的cox模型，并满足PH假定，为结直肠癌独立的预后因素；对不同PI值分组，组间生存率存在差异（P〈0．001）；以PI值中位数作为基准，随机选取PI=3．0的个体，该个体相对于基准的预期1、3、5年生存率分别为33．1％、6．8％和3．5％。结论淋巴转移、Duckes分期、治疗方式是影响结直肠癌预后的独立因素；对Cox模型的人选因素有必要进行PH假定的检验；利用预后Cox模型和PI值可有效地预测结直肠癌患者的长期生存状况。

Study on the prognostic factors of colorectal cancer and on suggested model for prediction

OBJECTIVE: To explore the factors related to the prognosis of colorectal cancer (CRC) and to establish a prognostic model for evaluating the prognosis of the patients with CRC. METHODS: 370 cases with CRC were selected in the study and clinical/pathological factors were collected and patients were followed. Kaplan-Meier method was used to calculate survival rate. Log-rank test and proportional-hazards regression model (Cox model) were used for univariate and multivariate analysis. Log cumulative hazards function plot was used to test Cox model proportional-hazards assumption (PH assumption). Prognostic index (P1) was calculated based on the results of multivariate analysis. RESULTS: (1) One-year, three-year and five-year survival rates were 90.5%, 78.3% and 76.5% respectively. (2) Lymphatic metastasis, Duckes classification and therapeutic measure were independent prognostic factors of CRC and all passed PH assumption. (3) Patients with different PI were classified into 3 groups and there were significant differences noticed in survival rates (P < 0.001). (4) Individual survival rate was evaluated based on the prognostic Cox model and PI. CONCLUSION: Lymphatic metastasis, Duckes classification and therapeutic measure were independent prognostic factors of CRC. To test PH assumption of the factors, selection of Cox model was essential. Cox model and PI seemed to be available in predicting the long term survivrate of patients with CRC.