中国实用外科杂志

中国实用外科杂志

• 论蓍 • 上一篇    下一篇

青年结直肠癌病人临床病理学特征及预后分析

黄群生1，钟克力2，何晓生1，陈    平1，熊家庆1，吴小剑1，兰    平1，练    磊1   

  1. 1中山大学附属第六医院结直肠外科 广东省结直肠盆底疾病研究重点实验室，广东广州510655；2暨南大学第二临床学院附属深圳市人民医院胃肠外科，广东深圳518020
  • 出版日期:2018-06-01 发布日期:2018-06-21

  • Online:2018-06-01 Published:2018-06-21

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。

关键词: 结直肠癌, 青年病人, 临床病理学特征, 预后

Abstract:

Clinicopathologic characteristics and prognosis analysis of young patients with colorectal cancer        HUANG Qun-sheng*, ZHONG Ke-li，HE Xiao-sheng, et al. *Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, Guangzhou 510655, China
Corresponding author: LIAN Lei, E-mail: lianlei2@mail.sysu.edu.cn
HUANG Qun-sheng and CHENG Ke-li are the first authors who contributed equally to the article
Abstract    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）， Ⅲ and Ⅳ stages 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.

Key words: colorectal cancer, young patient, clinicopathologic characteristics, prognosis