| 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1、3與5年存活率為87.0％、65.6％與57.7％。Cox向前逐步迴歸模型分析結果顯示，整體病患以遠端器官轉移、LNR大於等於0.08、術前CEA濃度大於等於5 ng/ml、罹病年齡大於等於65歲與淋巴血管侵犯之病患死亡風險較高。整體、第二期與第三期病患接受手術切除合併化學治療的死亡風險相對於只接受手術治療的病患低。術前CEA濃度與第二期病患死亡風險有顯著相關，但與第三期病患死亡風險無關。淋巴結擴清數量大於等於10顆之第二期病患有較好的存活預後；淋巴血管侵犯與淋巴結轉移大於等於4顆之第三期病患其存活預後較差。結論：遠端器官轉移、只接受手術切除治療、淋巴結比率大於0.08與術前CEA濃度高於正常值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。大腸直腸癌病患手術後併化學治療有利於提高存活率。
Objectives: 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 87.01% at 1year, 65.57% at 3years, and 57.65% at 5 years in 464 patients. From the forward stepwise Cox regression model, having distant metastasis, LNR ≥0.08, presurgery serum CEA level ≥5ng/ml, age of onset of CRC ≥65 years and lymphatic vessel invasion were independently associated with higher mortality in the entire patient cohort. As expected, patients treated with surgery plus chemotherapy had decreased mortality risk compared with surgery alone in patients with stage I to IV, Stage II or stage III CRC. Presurgery serum CEA level was independently negatively associated with mortality among patients with stage II, but the result not in patients with stage III. Total number of retrieved lymph node ≥10 was associated with a better prognosis in stage II CRC. Lymphatic vessel invasion and the number of lymph node metastasis ≥4 were independently associated with worse survival in patients with stage III CRC. Conclusion: Distant metastasis, treat with surgery alone, high LNR and high presurgery serum CEA level are an independent risk factor for poor prognosis in patients with CRC. Having distant metastasis appears to be an important prognostic factor refer to the entire patient cohort, earlier detection of CRC would likely improve survival of patients. CRC patients would benefit from chemotherapy after surgery. |
