1 368例结直肠癌TNM分期及预后分析

  目的  研究我国不同TNM分期的结直肠癌治疗后的生存情况及其影响因素，以帮助判断预后。  方法  使用SPSS 19.0软件对1985年1月至2005年12月间于浙江大学医学院附属第二医院经手术病理证实的1 368例结直肠癌患者的19个临床及病理因素进行分析，单因素分析时采用Kaplan-Meier法计算生存率，Log-rank法比较生存率差异。多因素分析时采用Cox风险比例模型，得出影响结直肠癌患者预后的独立因素。按AJCC第七版TNM分期标准，对所有患者进行分期。  结果  1 368例患者3、5、10年总生存率分别为67.5%、60.2%、53.5%；根治术后3、5、10年生存率分别为77.6%、69.9%、62.4%。按AJCC第七版TNM分期，Ⅰ、Ⅱ、Ⅲ、Ⅳ期的5年生存率分别为90.1%、72.6%、53.8%、10.4%。Cox模型多因素分析发现肿瘤浸润深度、转移淋巴结数、送检淋巴结总数、邻近器官受累、远处转移、手术方式和术后感染等7个因素是影响结直肠癌预后的主要独立因素。尤其是ⅡC期患者的5年生存率（44.8%）低于ⅢA期（79.6%）、ⅢB期（58.0%），上述各因素的生存曲线比较其差异有统计学意义（P < 0.05）。  结论  肿瘤浸润深度、转移淋巴结数、送检标本淋巴结总数、邻近器官受累、远处转移、手术方式和术后感染等7个因素是影响结直肠癌预后的主要独立因素。原发肿瘤的浸润深度对于Ⅱ/Ⅲ期结直肠癌患者的预后可能更有提示作用。 

TNM Classification and Prognostic Factors of 1 368 Patients with Colorectal Cancer

  Objective  To assess the survival rates of patients with different TNM stages, and to explore the prognostic factors of colorectal cancer.  Methods  A total of 1, 368 cases of colorectal cancer operated and pathologically confirmed at the Second Affiliated Hospital of Zhejiang University School of Medicine from 1985 to 2005 were collected. All cancers were pathologically staged according to AJCC TNM classification (seventh edition). Univariate and multivariate analyses were applied to evaluate the prognostic factors. For univariate analysis, the cumulative survival rate was calculated using the Kaplan-Meier method, and the significant difference was evaluated by the log-rank test. Cox multivariate regression analysis was performed to identify the predictors of survival. All these analyses were conducted using SPSS software (version 19.0).  Results  The 3-, 5-, and 10- year overalll survival rates were 67.5%, 60.2%, and 53%, respectively. The survival rates for 3, 5, and 10 years after radical resection were 77.6%, 69.9%, and 62.4% respectively. According to the TNM classification, the 5-year survival rates of the stage-Ⅰ, -Ⅱ, -Ⅲ, and -Ⅳ patients were 90.1%, 72.6%, 53.8%, and 10.4%, respectively. Multivariate analysis by Cox regression revealed that the following factors were independently associated with the cumulative survival rate of colorectal cancer: depth of invasion, lymph node metastasis, total number of lymph nodes, adjacent organ involvement, metastasis, radical resection, and post-operative infection. The 5-year overall survival rate was lower in stage-ⅡC patients than in stage-ⅢA or -ⅢB patients. The survival curves of the above factors were significantly different (P < 0.05).  Conclusion  The depth of invasion, lymph node metastasis, total number of lymph nodes inspected after surgery, adjacent organ involvement, metastasis, radical resection, postoperative infection are the independent prognostic factors of colorectal cancer. The depth of invasion may be a more precise prognostic factor for stage-Ⅱ and -Ⅲ patients.