高龄结肠直肠癌患者根治切除术的预后因素分析

目的 探讨影响70岁以上高龄结直肠癌患者根治切除术的预后因素.方法 回顾性分析中国医学科学院肿瘤医院1992年1月至2001年12月间收治的263例70岁以上高龄结直肠癌患者的临床病理资料.采用Kaplan-Meier法进行生存分析,Log-rank检验进行统计学比较;应用Cox比例风险模型进行多因素分析.结果 全组患者平均年龄74.9岁,147例(55.9%)为男性.术后发生并发症者38例(14.4%),手术后30 d内死亡3例(1.1%).全组5年生存率为70.5%,Ⅰ、Ⅱ和ⅢC期的5年生存率分别为84.8%、71.8%和61.9%.单因素分析显示:年龄、合并症、癌性肠梗阻、ASA评分、术前贫血、术前低自蛋白血症、手术并发症、肿瘤大体类型、肿瘤浸润深度、淋巴结转移及分期与预后相关.多因素回归分析显示:年龄、合并症、手术并发症、术前低蛋白血症、肿瘤大体类型、肿瘤浸润深度、淋巴结转移及分期是影响高龄结直肠癌患者根治切除术预后的独立因素.结论 高龄结直肠癌患者行根治性切除术预后较好,年龄、合并症、手术并发症、术前低蛋白血症、肿瘤大体类型、肿瘤浸润深度、淋巴结转移及分期是影响其预后的独立因素.

Prognostic factors of colorectal carcinoma in the elderly after radical surgery

Objective To evaluate the prognostic factors of colorectal carcinoma in the elderly aged over 70 after radical surgery.Methods 263 colorectal carcinoma patients aged 74.9,147 males and 115 females.underwent radical surgery,including right hemieolectomy(n=48),left hemicolectomy(n:11),transverse colectomy(n=8), sigmoid resection(n=27),low anterior resection(n=103),abdominoperineal rlesection(n=58),and Hartmann's operation(n=7). Survival analysis was condueted using Kaplan-Meier method, and multivariate analysis wag conducted with Cox regressmn to analyze the prognostic factors.Results The post-operative complication rate was 14.4%.The 30-day mortality wag 1.1%.The overaill 5-year survival rate was 70.5%,and the 5-year survival rates of the patients with ASA grades Ⅰ,Ⅱ,and Ⅲ were 84.8%,71.8%,and 61.9%respectively.Univariate analysis showed that the Dredictors of survival were age,co-morbidity,ASA score,postoperative complication,preoperative serum albumin conccntration.preoperative hemoglobin level,gross tumor configuration,tumor stage, neoplastic intestinal obstruction,and lymph node metastasis. Multivariate analysis showed that patient sex,complication, operative complication, gross tumor configuration,depth of infiltration, lymph node metastasis,and tumor staging were independent influencing factors od prognosis. Conclusion The prognosis of colorectal carcinoma in the elderly after radical surgery is good.The prognostic factors include age,postoperative complication, and pre-operative serum albumin concentration,and gross tumor configuration,depth of tumor invasion,lymph node metastasis,and tumor stage.