摘要
目的探讨Ⅳ期右半结肠癌患者接受姑息性手术的疗效,并分析预后不良的危险因素。方法纳入2013年1月至2016年6月于本院接受姑息性手术的97例Ⅳ期右半结肠癌患者为研究对象,术后随访3年,观察手术治疗效果及患者生存情况,采用Cox回归模型分析观察组预后不良的危险因素。结果 97例患者均手术成功,未见30d内死亡患者,术后45例出现并发症。随访期间79例死亡,患者总体中位生存时间11.0个月,1年、2年、3年累积生存率分别为45.4%、24.7%、18.8%。T_4分期、N_2分期、术前梗阻、伴腹膜种植、术前癌胚抗原升高是患者预后不良的危险因素(OR=2.535、2.111、3.474、2.667、4.685,均P<0.05),术后接受靶向治疗是患者预后的保护因素(OR=-0.497,P<0.05)。结论姑息性手术对治疗Ⅳ期右半结肠癌有一定价值;T_4分期、N_2分期、术前梗阻、伴腹膜种植、术前癌胚抗原升高是患者预后不良的危险因素,术后接受靶向治疗是患者预后的保护因素。
Objective To investigate the clinical effect of palliative surgery for patients with stage Ⅳ right-sided colon cancer, and to analyze the risk factors for poor prognosis. Methods 97 patients with stage Ⅳ right-sided colon cancer treated with palliative surgery during January 2013 to June 2016 were selected as the research subjects and were followed-up of 3 years. The clinical effect of the surgery and cumulative survival rate were recorded. Risk factors for poor prognosis were analyzed using Cox regression. Results Surgeries for the 97 patients were successful. No patient died within 30 days of surgery. 45 patients developed complications. 79 cases died during following-up. The overall median survival time was 11.0 months, and the cumulative survival rates were 45.4%, 24.7% and 18.8% at 1, 2 and 3 years, respectively. Stage T_4, stage N_2, preoperative obstruction, peritoneal implantation, and high levels of preoperative carcinoembryonic antigen were risk factors of poor prognosis（OR = 2.535, 2.111, 3.474, 2.667, and 4.685, respectively, all P〈0.05）. Postoperative targeted therapy was the protective factor for prognosis（OR =-0.497, P〈0.05）. Conclusion Palliative surgery is valuable for the treatment of stage Ⅳ right-sided colon cancer. Stage T_4, stage N_2, preoperative obstruction, peritoneal implantation, and high levels of preoperative carcinoembryonic antigen are risk factors for poor prognosis. Postoperative targeted therapy was the protective factor for prognosis.
作者
丁海滨
Ding Haibin(Department of Thoracic Surgery,Tianmen First People＇s Hospital,Tianmen,Hubei,431700,China)
出处
《结直肠肛门外科》
2018年第4期355-359,共5页
Journal of Colorectal & Anal Surgery
关键词
Ⅳ期右半结肠癌
姑息切除术
预后
危险因素
stage IV right-sided colon cancer
palliative surgery
prognosis
risk factors
