摘要
目的 比较早发性与晚发性进展期直肠黏液腺癌的临床病理特征的差异并分析其预后.方法 本研究通过SEER数据库收集了2010-2020年首次诊断为进展期直肠黏液腺癌的患者作为研究对象.按照确诊时年龄进行分组,分为早发性(确诊时年龄＜50岁)进展期直肠黏液腺癌组(早发组,共155例)和晚发性(确诊时年龄≥50岁)进展期直肠黏液腺癌组(晚发组,共679例).比较两组的临床病理特征,并进行生存分析.结果 两组不同性别、种族、分化程度、T分期、术前CEA水平、周围神经浸润、肿瘤长径的患者比例比较差异无统计学意义(P＞0.05);与晚发组相比,早发组的离婚、分居或丧偶(11.6％vs.27.4％)、淋巴结清扫数目1～11枚(19.4％vs.27.4％)、癌结节阴性(67.7％vs.76.1％)的患者比例更低,TNM Ⅲ期(76.1％vs.58.6％)、N2期(33.5％vs.18.1％)、淋巴结清扫数目＞20枚(29.7％vs.19.9％)、淋巴结阳性(58.1％vs.45.4％)、接受化疗(93.5％vs.78.8％)、接受术前放疗(75.5％vs.56.1％)、接受全程系统治疗(41.3％vs.21.2％)的患者比例更高(P＜0.05).两组最长随访时间为131个月,随访期间,早发组与晚发组的总生存率分别为59.4％和45.5％,5年生存率分别为66.1％和57％.早发组的平均生存时间为91.885个月;晚发组的中位生存时间为76个月,平均生存时间为78.348个月.Breslow检验(Wilcoxon检验)和Log-rank检验结果均提示早发组的生存率高于晚发组(P＜0.05).对全组834例进展期直肠黏液腺癌进行Cox比例风险回归模型分析,结果显示,晚发性(确诊时年龄≥50岁)、男性、不稳定的婚姻状态(离婚、分居或丧偶,未婚或未知)、N2期、周围神经浸润阳性、肿瘤长径＞5 cm、未行化疗、行术前+术后放疗和行术前系统治疗是进展期直肠黏液腺癌生存预后的独立危险因素.对155例早发性进展期直肠黏液腺癌进行Cox比例风险回归模型分析,结果显示未婚或未知婚姻状态和周围神经浸润阳性是早发性进展期直肠黏液腺癌生存预后的独立危险因素.结论 早发性进展期直肠黏液腺癌不良预后因素发生的可能性更高,比如早发性患者的Ⅲ期、淋巴结阳性比例更高,而癌结节阴性比例更低.然而,其长期或短期生存结局均优于晚发性进展期直肠黏液腺癌,这可能和手术中充分清扫了淋巴结和接受化疗有关.
Abstract
Objectives To compare the clinicopathological features with early-onset and late-onset advanced rectal muci-nous adenocarcinoma and analysis the prognosis.Methods This study collected patients with first diagnosed advanced rectal mucinous adenocarcinoma from 2010 to 2020 through the SEER database.According to the age at diagnosis,pa-tients were divided into an early-onset group(age＜50 years at diagnosis,totaling 155 cases)and a late-onset group(age ≥ 50 years at diagnosis,totaling 679 cases).The clinicopathological features of the two groups were compared,and survival analysis was performed.Results There were no significant differences in the proportions of patients of different genders,races,degrees of differentiation,T stages,preoperative CEA,perineural invasion,and tumor diameters between the two groups(P＞0.05).Compared with the late-onset group,the early-onset group had lower patients proportions of divorce,separation,or widowhood(11.6％vs.27.4％),1-11 lymph node dissections(19.4％vs.27.4％),and cancer nodule negativity(67.7％vs.76.1％).However,the early-onset group had higher patients proportions of TNM stage Ⅲ(76.1％vs.58.6％),N2 stage(33.5％vs.18.1％),＞20 lymph node dissections(29.7％vs.19.9％),lymph node positivity(58.1％vs.45.4％),receiving chemotherapy(93.5％vs.78.8％),receiving radiotherapy(75.5％vs.56.1％),and receiving full course sys-temic therapy(41.3％vs.21.2％)(P＜0.05).The longest follow-up time for both groups was 131 months.During the follow-up period,the overall survival rates of the early-onset and late-onset groups were 59.4％and 45.5％,and the 5-year survival rates were 66.1％and 57％,respectively.The average survival time of the early-onset group was 91.885 months,while the median survival time of the late-onset group was 76 months,with an average survival time of 78.348 months.Both Breslow test(Wilcoxon test)and Log-rank test results indicated that the survival rate of the early-onset group was higher than that of the late-onset group(P＜0.05).Cox proportional hazards regression model analysis was performed on 834 cases of advanced rectal mucinous adenocarcinoma,revealing that late-onset(age ≥ 50 years at diagno-sis),male gender,unstable marital status(divorce,separation,widowhood,unmarried,or unknown),N2 stage,positive perineural invasion,tumor diameter＞5 cm,no chemotherapy,preoperative+postoperative radiotherapy,and preoperative systemic therapy were independent risk factors for survival prognosis in advanced rectal mucinous adenocarcinoma.Cox proportional hazards regression model analysis was also performed on 155 cases of early-onset advanced rectal mucinous adenocarcinoma,showing that unmarried or unknown marital status and positive perineural invasion were independent risk factors for survival prognosis in early-onset advanced rectal mucinous adenocarcinoma.Conclusion The possibility of adverse prognostic factors is higher in early-onset advanced rectal mucinous adenocarcinoma,such as a higher propor-tion of stage Ⅲ and lymph node positivity,and a lower proportion of cancer nodule negativity.However,its long-term or short-term survival outcomes are superior to those of late-onset advanced rectal mucinous adenocarcinoma,which may be related to adequate lymph node dissection during surgery and chemotherapy receipt.
基金项目
合肥市第七周期临床重点专科建设项目(普外科—结直肠肛门外科)()
维普
万方数据