摘要
目的:探讨对于行根治性切除术的非转移性结肠癌患者率肿瘤大小在不同TNM分期中对预后的影响。方法:采用回顾性队列研究的方法收集SEER数据库中2010年至2015年行根治性手术治疗的Ⅰ-Ⅲ期结肠癌患者的临床资料,利用X⁃Tile软件根据肿瘤最大直径将患者分为小直径组、中等直径组及大直径组。采用Kaplan⁃Meier法绘制生存曲线估计患者癌症特异性生存期(CSS),采用Log⁃rank检验对生存差异进行评估,采用Cox回归模型分别进行单因素及多因素回归分析评估肿瘤大小分别在Ⅰ期、Ⅱ期及Ⅲ期结肠癌患者中的预后作用,利用限制性立方样条(RCS)函数来对肿瘤大小与癌症特异性死亡风险之间的关系来进行曲线拟合。结果:本研究最终纳入统计分析患者共计17627例,利用X⁃Tile软件对肿瘤大小进行分组,选取截断值分别为2.8 cm与8.0 cm。分组后小直径组3803(21.57%)例,中等直径组11812(67.01%)例,大直径组2012(11.41%)例,所有患者中位随访时间为45(P_(25)~P_(75):29~66)个月,末次随访中因肿瘤死亡患者2862例(16.24%),患者总体5年癌症特异性生存率为81.48%[95%置信区间(95%CI):80.82%~82.15%]。对于Ⅰ期结肠癌患者,较大的肿瘤预示着患者不良预后的趋势,但多因素Cox回归分析无统计学意义[风险比(HR)=1.06,95%CI:0.98~1.14,P>0.05]。对于Ⅱ期结肠癌患者,肿瘤大小与患者癌症特异性死亡的风险之间呈U形关系而非简单的线性关系。而在Ⅲ期患者中,较大的肿瘤是结肠癌患者不良预后的独立危险因素(HR=1.08,95%CI:1.06~1.10,P<0.001)。结论:肿瘤大小是Ⅲ期结肠癌患者不良预后的独立危险因素;在Ⅱ期结肠癌患者中,肿瘤大小与预后之间呈U形关系;在Ⅰ期结肠癌患者中,肿瘤大小与预后无显著关联性。肿瘤大小对结肠癌患者预后的影响应结合肿瘤具体TNM分期来判断。
Objective:To investigate the influence of tumor size on the prognosis of patients with different TNM⁃stage non⁃metastatic colon cancer undergoing radical resection.Methods:A retrospective cohort study design was used to retrieve the clinical data of patients with stagesⅠ-Ⅲcolon cancer who underwent radical surgery between 2010 and 2015 in the SEER(The Surveillance,Epidemiology,and End Results)database.According to the maximum diameter of the tumor,the patients were divided into the small,medium and large diameter groups by using the X⁃Tile software.Kaplan⁃Meier method was used to generate the survival curve for estimation of the cancer specific survival(CSS)in the patients.Log⁃rank test was used to evaluate the difference in survival.Cox regression model was used forunivariate and multivariate regression analysis to evaluate the prognostification of tumor size in patients with stage I,ⅡorⅢcolon cancer.Restricted cubic spline(RCS)was used for curve fitting of the relationship between tumor size and risk of cancer⁃specific death.Results:In this study,a total of 17627 patients were included in the statistical analysis.X⁃Tile software assigned the groups by tumor size with cutoff values of 2.8 cm and 8.0 cm,respectively.After group assignment,there were 3803(21.57%)cases in the small diameter group,11812(67.01%)in the medium diameter group,and 2012(11.41%)in the large diameter group.The median duration of follow⁃up for all patients was 45(P_(25)~P_(75):29~66)months.In the last follow⁃up,2862 patients(16.24%)had died of tumors.The overall 5⁃year cancer⁃specific survival rate in the patients was 81.48%(95%CI:80.82%~82.15%).For patients with stage I colon cancer,larger tumors tended to predict a poor prognosis,but the multivariate Cox regression analysis did not reveal a statistically significant difference(HR=1.06,95%CI:0.98~1.14,P>0.05).For patients with stageⅡcolon cancer,there was a U⁃shaped but not a simple linear relationship between tumor size and the risk of cancer⁃specific death.For stageⅢpatients,larger tumors were shown to be an independent risk factor for poor prognosis of colon cancer patients(HR=1.08,95%CI:1.06~1.10,P<0.001).Conclusion:Tumor size is an independent risk factor for poor prognosis in patients with stageⅢcolon cancer.In patients with stageⅡcolon cancer,there is a U⁃shaped relationship between tumor size and prognosis.In patients with stage I colon cancer,there is no significant correlation between tumor size and prognosis.The influence of tumor size on the prognosis of colon cancer patients should be judged in conjunction with the specific TNM staging of the tumor.
作者
杜昆
杜宁超
廖木春
刘安文
陈小岚
Du Kun;Du Ningchao;Liao Muchun;Liu Anwen;Chen Xiaolan(Department of Anorectal Surgery,Shenzhen Second People’s Hospital,Shenzhen 518035,China;Department of Gastrointestinal Surgery,Shenzhen Second People’s Hospital,Shenzhen 518035,China)
出处
《广州医科大学学报》
2021年第2期22-31,共10页
Academic Journal of Guangzhou Medical University
关键词
结肠癌
肿瘤大小
预后
危险因素
Colon cancer
Tumor size
Prognosis
Risk factors
