婚姻状态显著影响结肠腺癌术后患者的生存预后

发布时间：2018-02-05 22:37

本文关键词： 婚姻状态结肠腺癌全因死亡率肿瘤特异性死亡率 SEER数据库　出处：《南方医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景:结肠癌是男性第三常见、女性第二常见的恶性肿瘤,不管是发病率还是死亡率都非常高。结直肠癌患者的生存预后和很多因素相关,如患者年龄、性别、种族、肿瘤部位、肿瘤分化程度、淋巴结状态、肿瘤分期、分子病理或基因突变情况、治疗策略、社会心理状态等。既往研究发现婚姻状态对结肠癌及其他癌症的生存期有显著影响,目前尚无婚姻状态对结肠癌术后患者死亡率的影响的有关研究。研究目的:比较已婚结肠腺癌术后患者和非已婚结肠腺癌术后患者的生存预后。研究方法:本研究从美国SEER数据库收集2004年至2009年期间进行了结肠癌手术的病例共了71,955例。首先利用Cox等比例回归模型进行单因素、多因素分析,分析婚姻状态对结肠癌术后患者死亡率的影响,并用Therneau-Grambsch试验进行等比例假设检验。纳入分析的变量包括:年龄、性别、种族、婚姻状态、淋巴结率、肿瘤部位、肿瘤分化程度、TNM分期共8个变量。若有变量不满足等比例假设,改用Cox扩展模型分析婚姻状态对结肠癌术后患者死亡率的影响。利用Fine-Gray竞争风险模型分析婚姻状态对结肠癌术后患者结肠癌特异性死亡率的影响,在这个模型中其它原因的死亡被认为是竞争风险。研究结果:Cox扩展模型结果示,纳入分析的八个变量都是结肠癌术后患者全因死亡率的独立预测因子。非已婚结肠癌术后患者死亡的风险是已婚组的1.37倍,差异具有统计学意义(HR,1.37;95%CI,1.33-1.40;p0.001),且这个风险不随时间改变而改变。Fine-Gray竞争风险模型结果示,非已婚组的结肠癌特异性死亡率比已婚组高20.7%,具有统计学差异(HR,1.21;95%CI,1.17-1.24;p0.001)。非已婚患者其他原因死亡率也显著高于已婚患者,具有统计学差异(p0.001)。此外,肿瘤部位、肿瘤分化程度、性别、TNM分期不满足等比例假设(P0.05),它们对全因死亡率的影响随时间变化而变化。研究结论:婚姻状态是结肠癌术后患者的一个非常有价值的预后指标。非已婚结肠癌术后患者的全因死亡率、结肠癌特异性死亡率、其他原因死亡率显著高于已婚结肠癌术后患者。非已婚患者预后差的具体机制不明,可能与结直肠癌筛查率低、手术接受率低、辅助治疗几率低、姑息治疗几率低、心理压力大有关。临床医生在给结肠癌患者提供个体化治疗时,应重视患者的婚姻状态,提高非已婚患者的治疗积极性、依从性,也许他们的生存预后会有所改善。
[Abstract]:Background: colon cancer is the third most common malignant tumor in men and the second most common malignant tumor in women. Both morbidity and mortality are very high. The survival and prognosis of colorectal cancer patients are related to many factors such as age. Sex, race, tumor location, tumor differentiation, lymph node status, tumor staging, molecular pathology or gene mutation, treatment strategy. Previous studies have found that marital status has a significant impact on the survival of colon cancer and other cancers. There is no study on the effect of marital status on postoperative mortality of colon cancer patients. Objective: to compare the survival and prognosis of married patients with colon adenocarcinoma and those with nonmarried colon adenocarcinoma. This study collected 71 patients who underwent colon cancer surgery between 2004 and 2009 from the SEER database in the United States. 955 cases. First, univariate and multivariate analysis was carried out using Cox's proportional regression model to analyze the influence of marital status on postoperative mortality of colon cancer patients. The variables included age, sex, race, marital status, lymph node rate and tumor site. There were 8 variables of tumor differentiation and TNM stage. If there were variables which did not satisfy the equal proportion hypothesis. Cox extended model was used to analyze the effect of marital status on postoperative mortality of colon cancer patients. The Fine-Gray competitive risk model was used to analyze the specific mortality rate of colon cancer patients after colon cancer operation by using the Fine-Gray competitive risk model. The impact. Other causes of death in this model are considered to be competitive risks. The eight variables included in the analysis were independent predictors of all-cause mortality in postoperative colon cancer patients. The risk of death in non-married postoperative colon cancer patients was 1.37 times higher than that in married patients, and the difference was statistically significant. 1.37; 95 CII 1.33-1.40; The risk did not change over time. Fine-Gray 's competitive risk model showed that colon cancer specific mortality was 20.7% higher in the non-married group than in the married group. There was statistical difference in HR1. 21; 95 CIQ 1.17-1.24; The mortality rate of non-married patients was significantly higher than that of married patients (P 0.001). In addition, tumor location, tumor differentiation and sex were significantly higher in non-married patients than in married patients. The TNM stage was not satisfied with the equal proportion hypothesis (P0.05). Their effect on total mortality changes over time. Conclusion: marital status is a very valuable prognostic indicator for postoperative patients with colon cancer. The specific mortality rate of colon cancer was significantly higher than that of married patients after operation. The mechanism of poor prognosis in non-married patients was unclear, which may be associated with the low screening rate of colorectal cancer and the low acceptance rate of surgery. The clinical doctors should pay attention to the marital status of patients with colon cancer and improve the treatment enthusiasm of non-married patients when providing individualized treatment for colon cancer patients with low probability of adjuvant treatment, low probability of palliative treatment and great psychological pressure. Compliance may improve their survival and prognosis.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.35

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