直肠癌患者生存随访调查及预后影响因素研究

Investigation of survival follow-up and analysis of prognostic factors in patients with rectal cancer

摘要:

目的：分析重庆市有特殊病种医保的直肠癌患者生存情况，为直肠癌预后评价及防治提供参考依据。方法：采用回顾性队列研究方法，收集重庆市恶性肿瘤特殊疾病办理系统中2010年1月至2018年12月确诊的3 734例直肠癌患者临床病历资料。观察指标：①人口学特征：年龄、性别、民族、婚姻、职业；②生活习惯：吸烟史及饮酒史；③临床治疗及病理学检查情况：是否手术治疗、病理类型、TNM分期；④患者随访结果：生存情况；⑤预后因素分析。采用门诊复查、电话随访，以患者死亡为终点，了解患者生存状况，随访时间截至2018年12月31日。计量资料以均数±标准差（x±s）表示，计数资料采用绝对数（%）表示；采用Kaplan-Meier法计算生存率；单因素分析采用对数秩检验（log-rank test），多因素分析采用Cox比例风险回归模型进行分析；采用GraphPad Prism 8.0绘制生存曲线。结果：①3 734例直肠癌患者的人口学特征：年龄25～107岁，平均年龄（63.48±12.07）岁；男性患者2 389例，占63.98%；汉族患者占99.09%；已婚患者占94.80%。②生活习惯：现在还在吸烟的患者974例，占27.25%；现在还在饮酒的患者929例，占26.23%。③临床治疗及病理学结果：浸润深度T4的患者占43.35%；有阳性淋巴结的患者占51.54%；有远处转移的患者占11.72%；TNM临床分期中Ⅲ～Ⅳ期患者占76.64%；腺癌患者占94.09%。④随访结果：最终完成随访2 971例（79.57%）；研究对象的中位生存时间为99.29个月（95%CI=91.01～107.57），1、3、5年观察生存率分别为91.62%、74.47%、62.98%。⑤预后影响因素分析：单因素提示不同年龄、性别、婚姻状况、吸烟史、浸润深度（T）、有无阳性淋巴结（N）、是否远处转移（M）、TNM分期、手术与否及组织分化程度的患者预后差异均有统计学差异，不同民族、职业、饮酒史及病理类型的患者预后差异无统计学意义；多因素分析结果提示年龄、浸润深度（T）、有无阳性淋巴结（N）、TNM分期、组织分化可能是影响直肠癌患者预后的危险因素。结论：直肠癌患者预后影响因素较多，其中年龄、浸润深度（T）、有无阳性淋巴结（N）、TNM分期、组织分化可能是影响直肠癌患者预后的危险因素。加强健康教育、早期筛查诊断，有利于改善直肠癌患者的生存预后。

Abstract:

Objective：To analyze the survival of patients with rectal cancer who have special medical insurance in Chongqing，and provide reference for prognosis evaluation and prevention of rectal cancer. Methods：The retrospective cohort study was conducted and a total of 3 734 patients with rectal cancer were enrolled who were diagnosed and treated from January 2010 to December 2018 in the Chongqing Malignant Tumor Treatment System. Observation indicators：①Demographic characteristics：age，gender，nation－ality，marriage and occupation. ②Habits：smoking history and alcohol-drinking history. ③Clinical treatment and pathological examination：surgery，pathological type and TNM stage. ④Results of patient follow-up：survival status. ⑤Analysis of prognostic factors. Follow-up by telephone and out-patient review. Death was regarded as end point and follow-up was ended on Decem－ber 31，2018. The mean ± SD（x±s） was used to demonstrate the measurement data，and the absolute number（%） was used to demon－strate counting data；the survival rate was calculated by Kaplan-Meier method；the log-rank test was used for single factor analysis；the Cox proportional hazards regression model was used for multivariate analysis；GraphPad Prism 8.0 was used to draw survival curves. Results：①The demographic characteristics of 3 734 patients with rectal cancer were：25-107 years old，with an average age of （63.48±12.07） years old；male patients of 2 389，accounted for 63.98%；Han nationality accounted for 99.09%；married patients accounted for 94.80%. ②Results of living habits：974 patients kept smoking，accounting for 27.25%；929 patients kept drinking，ac－counting for 26.23%. ③Results of clinical treatment and pathology：patients with infiltration depth of T4 accounted for 43.35%，patients with positive lymph nodes accounted for 51.54% and patients with distant metastasis accounted for 11.72%. Patients with stage Ⅲ-Ⅳ accounted for 76.64% and patients with adenocarcinoma accounted for 94.09%. ④Follow-up results：2 971 patients（79.57%） finished followed up. The median survival time was 99.29 months（95%CI=91.01-107.57），and observed survival rates at the 1st，3nd and 5th year were 91.62%，74.47% and 62.98%，respectively. ⑤Analysis of prognostic factors：univariate analysis showed that survival prognosis of age，gender，marital status，smoking history，infiltration depth（T），positive lymph nodes（N），distant metastases（M），TNM staging，surgical treatment，and tissue differentiation had statistically significant differences，but nationalities，occupations，drinking history and pathological types had no statistically significant differences. Multivariate analysis indicated that age，infiltration depth（T），positive lymph nodes（N），TNM staging and tissue differentiation were likely to be risk factors influencing prognosis of rectal cancer patients. Conclusion：There are many factors influencing prognosis of rectal cancer patients，among which age，infiltration depth（T），positive lymph node（N），TNM staging and tissue differentiation may be risk factors. Enhancing health education and early screening di－agnosis are beneficial to improve the prognosis of rectal cancer patients.