大腸直腸癌病患術後存活後預測因子分析

Analysis of Prognostic Factors to Predict Postoperative Colorectal Cancer Patients Survival

方詩晴(Shih-Ching Fang) ； 趙東波(Tung-Bo Chao) ； 董弘一(Hong-Yi Tung) ； 陳昱甫(Yu-Fu Chen) ； 楊美雪(Mei-Hsueh Yang) ； 鄭麗芳(Li-Fang Cheng)

《南臺灣醫學雜誌》 10卷2期 (2014/12) Pp. 75-86

https://doi.org/10.6726/MJST.201412_10(2).0003

摘要

目的：探討大腸直腸癌病患術後存活預後預測因子，並進一步分析對死亡風險具重要性的預測因子。方法：以臺灣南部某區域醫院2004年～2009年大腸直腸癌新診斷術後病患464人為研究世代，第一、二、三與四期病患分別有43、145、164與102人，利用Kaplan-Meier分析病患存活率，以Cox向前逐步迴歸分析大腸直腸癌病患術後存活預後預測因子。結果：整體大腸直腸癌病患術後、3與5年存活率為87.0%、62.8%與55.7%。Cox向前逐步迴歸模型分析結果顯示，遠端器官轉移、淋巴結比率大於等於0.08、術前CEA濃度大於等於5ng/ml、罹病年齡大於等於65歲、淋巴血管侵犯與週邊神經侵犯之病患死亡風險較高。結論：遠端器官轉移、淋巴結比率大於等於0.08、罹病年齡大於等於65歲、術前CEA濃度高於正常值、週邊神經侵犯與淋巴血管侵犯之大腸直腸癌病患術後存活預後較差。遠端器官轉移與否對總體病患而言是最重要存活預後的預測因子，病患若能早期診斷可改善存活率。

關鍵字

大腸直腸癌 ； 存活時間 ； 預後因子

並列摘要

Objective: This study aimed to determine the factors affecting survival, following resection of large bowel for colorectal carcinoma (CRC), and consequently examined the factor that independently had the most important prognostic influence on survival. Methods: From the cancer database of a southern Taiwan hospital, the present retrospective cohort study selected 464 newly diagnosed CRC patients who had undergone colorectal resection between 2004 and 2009. This cohort included 43, 145,164 and 102 of CRC patients with stage I, II, III, and IV, respectively. Postoperative survival rates were estimated using the Kaplan-Meier method. Univariate Cox regression analysis was used to first assess the association between each various clinicopathological factor and survival, followed by forward stepwise Cox regression analysis for variable selection. Results: The overall survival was 87 .0% at 1 year, 62 .8% at 3 years, and 55.7% at 5 years in 464 patients. From the forward stepwise Cox regression model, having distant metastasis, LNR ≥0.08, preoperative serum CEA level ≥ 5ng/ml, age of onset of CRC ≥ 65 years, lymphovascular invasion and perineural invasion were independently associated with higher mortality in the entire patient cohort. Conclusions: Distant metastasis, a higher LNR, age of onset of CRC ≥65 years, high preoperative serum CEA levels, perineural invasion and lymphovascular invasion, and are an independent risk factor for poor prognosis in patients with CRC. Distant metastasis appears to be an important prognostic factor referred to the entire patient cohort, earlier detection of CRC would improve survival of patients.

並列關鍵字

colorectal cancer (CRC) ； survival ； prognostic factors