左右半结肠癌预后的差异及其相关因素的探讨

发布时间：2017-12-27 06:14

本文关键词：左右半结肠癌预后的差异及其相关因素的探讨　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:回顾性比较左、右半结肠癌的预后的差异,并探讨发生这种差异的相关影响因素,为结肠癌的个体化及精准化治疗提供科学的理论及临床依据。方法:收集广西医科大学附属肿瘤医院2012年12月至2014年12月明确病理诊断并具有较完整临床资料的422例原发性结肠癌患者进行回顾性分析。通过病史查阅、电话随访等方式收集患者年龄、性别、家族史、临床症状、首诊营养情况、分期、病理特征情况、无病生存期、生存期等资料。采用SPSS.17.0软件进行统计学分析。应用Kaplan-Meier法对左右半结肠癌患者预后进行生存分析,用log-rank检验对两者的生存曲线进行比较,对相关因素的计数资料采用构成比、率及卡方检验进行描述性分析,并通过Cox比例风险模型对结肠癌预后进行多因素回归分析,以P0.05为差异有统计学意义。结果:共收集病例资料422例,获得随访310例,随访率:73.46%。结肠癌患者预后的比较中,I期左、右半结肠癌2年无病生存曲线的比较无统计学意义(P=0.228)。II期两者2年无病生存曲线比较差异有统计学意义(P=0.009),左半结肠癌患者2年DFS较右半结肠癌患者高(89.5%/70.7%)。III期两者2年无病生存曲线比较差异无统计学意义(P=0.206),LCC及RCC 2年DFS分别为(59.5%/47.8%)。IV期两者2年生存率比较差异有统计学意义(P=0.038),左半结肠癌患者2年OS较右半结肠癌患者高(69.5%/43.1%)。相关因素比较:患者首诊时一般情况比较:在首诊分期、家族史、临床症状、无治疗病史长度的比较中差异具有明显统计学意义(P值分别为0.030、0.035、0.001、0.001)。在性别组的比较中差异不明显,P=0.048,接近0.05,故认为两者差异无统计学意义。而年龄组、吸烟史的比较差异无统计学意义(P0.05)。首诊时营养状况比较:BMI值、前白蛋白情况、血红蛋白情况的比较差异均有统计学意义(P值分别为0.001、0.003、0.001)。病理特征比较:瘤径大小、组织学类型、浸润深度、脉管内癌栓的比较中差异具有统计学意义(P值分别为0.013、0.001、0.001、0.003);大体病理类型、淋巴结转移情况、神经侵犯情况、微卫星表型的比较中差异无统计学意义(P0.05)。Cox多因素回归分析提示:1.组织学类型、癌栓情况、淋巴结转移是影响结肠癌整体预后的独立危险因素;2.癌栓情况为影响II期左半结肠癌预后的独立危险因素;3.癌栓情况及组织学类型为影响II期右半结肠癌预后的独立危险因素。结论:1.II期右半结肠癌比左半结肠癌有着更高的复发转移风险,II期及IV期右半结肠癌临床预后较差,其中组织学类型、脉管癌栓、淋巴结转移是影响其预后的主要因素。2.右半结肠癌患者首次就诊时营养状况较左半结肠癌患者差。3.右半结肠癌起病较隐匿,不容易早期被发现。
[Abstract]:Objective: To retrospectively compare the prognosis difference between left and right colon cancer, and to explore the related factors of this difference, so as to provide scientific theory and clinical basis for the individualized and precise treatment of colon cancer. Methods: a total of 422 patients with primary colon cancer who were diagnosed pathologically and had complete clinical data from December 2012 to December 2014 in Guangxi Medical University Affiliated Tumor Hospital were retrospectively analyzed. The patients' age, sex, family history, clinical symptoms, nutritional status, stage, pathological characteristics, disease free survival and survival time were collected through case history and telephone follow-up. SPSS.17.0 software was used for statistical analysis. Application of Kaplan-Meier method for survival analysis on the prognosis of patients with left colon cancer were compared by log-rank test, the survival curves of the two, count data on factors related to the proportion, ratio and chi square test were analyzed, and the Cox proportional hazards model for the prognosis of colon cancer multiple factors regression analysis, using P0.05 as a statistically significant difference. Results: a total of 422 cases were collected and 310 cases were followed up. The follow-up rate was 73.46%. In the comparison of the prognosis of colon cancer patients, there was no statistically significant difference in the 2 year disease free survival curve of left and right colon cancer in I (P=0.228). There was a significant difference in the 2 year disease free survival curve between the two II periods (P=0.009), and the 2 year DFS of left colon cancer patients was higher than that of the right half colon cancer patients (89.5%/70.7%). There was no significant difference in the 2 year disease-free survival curve between the two III periods (P=0.206), and the DFS of LCC and RCC was (59.5%/47.8%) respectively. There was a significant difference in the 2 year survival rate of the IV period (P=0.038). The 2 year OS of left colon cancer patients was higher than that of the right half colon cancer patients (69.5%/43.1%). Correlation factors: the general situation of patients at the first visit was compared: there was statistically significant difference in the stage of first visit, family history, clinical symptoms and the length of treatment history (P = 0.030, 0.035, 0.001, 0.001). The difference in the sex group was not obvious, P=0.048, close to 0.05, so there was no significant difference between the two groups. There was no significant difference in age group and smoking history (P0.05). Nutritional status at first visit: BMI, prealbumin and hemoglobin were statistically different (P = 0.001, 0.003, 0.001). Pathological features: there were significant differences in tumor size, histological type, depth of infiltration, intravascular cancer embolus (P = 0.013, 0.001, 0.001, 0.003); pathological type, lymph node metastasis, the difference of neural invasion, microsatellite phenotype was not statistically significant (P0.05). Cox regression analysis showed: 1. histological types, tumor thrombus, lymph node metastasis is the independent risk factors influencing the prognosis of colon cancer overall; 2. tumor thrombus wereindependent risk II left colon cancer prognostic factors; 3. tumor thrombus and histological type were independent risk stage right hemicolectomy with II prognostic factors of colorectal cancer. Conclusion: 1.II stage right colon cancer has a higher risk of recurrence and metastasis than left colon cancer. The prognosis of II and IV stage right colon cancer is poor. Histological type, vascular tumor thrombus and lymph node metastasis are the main factors affecting the prognosis. 2. the nutritional status of patients with right half colon cancer was worse than that of left colon cancer patients for the first time. 3. right hemi colon cancer is insidious, and it is not easy to be found early.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.35

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