Prognosis factor of patients with colorectal cancer: a retrospective study of surveillance, epidemiology, and end results population-based data

doi:10.3877/cma.j.issn.2095-3224.2017.01.005

Abstract

Abstract:

Objective

To explore the survival of different stage of patients with colorectal cancer, and evaluate the clinicopathologic factors associated with prognosis.

Methods

The SEER*Stat software was used to identify patients whose pathological diagnosis as colorectal malignancy from 2004 to 2009, and underwent surgical treatment. Univariate and Cox multivariate regression analysis were applied to evaluate the prognostic factors. The Kaplan-Meier method was used to calculate the cumulative survival rate, and the significant difference was evaluated by the log-rank test.

Results

The mean survival time of 1 829 colorectal cancer patients was (76.71±0.16) months, the median survival time was 98 months and the overall 5-year survival was 60.4%. The 5-year survival rates of the stage Ⅰ, Ⅱ, Ⅲ, Ⅳ patients were 81.2%, 71.7%, 58.4%, 14.4%, and the relationship between the overall survival was stage Ⅰ> stage Ⅱ> stage Ⅲ> stage Ⅳ (χ²=26 063.383; P<0.001). But, the overall survival of stage Ⅱwas located between stage ⅢA and ⅢB. The overall 5-year survival of stage ⅢA (78.7%) and ⅠB (79%) was almost (χ²=0.040; P=0.841), and better than ⅡA (χ²=39.409; P<0.001), ⅡB (χ²=212.271; P<0.001), ⅡC (χ²=307.720; P<0.001). The overall 5-year survival of stage ⅢB (61.5%) was better than stage ⅡB (60.1%) (χ²=4.366; P=0.037) and ⅡC (54.6%) (χ²=33.047; P<0.001), but worse than stage ⅡA (73.6%) (χ²=692.563; P<0.001). The factors of sex (χ²=5.662; P=0.017), years of diagnosis (χ²=100.476; P<0.001), race (χ²=227.960; P<0.001), primary site (χ²=457.809; P<0.001), pathological grading (χ²=2 364.001; P<0.001), adjacent organ involvement (χ²=3 475.630; P<0.001), depth of invasion (χ²=8 281.813; P<0.001), lymph node metastasis (χ²=12 034.484; P<0.001), total number of lymph nodes (χ²=362.497; P<0.001) and metastasis (χ²=23 960.974; P<0.001) influenced the survival rate by univariate analysis. The factors of sex (95%CI: 0.958~0.997; P=0.025), years of diagnosis (95%CI: 0.967~0.992; P=0.001), race (95%CI: 0.912~0.942; P<0.001), Primary site (95%CI: 0.896~0.912; P<0.001), Pathological grading (95%CI: 1.162~1.204; P<0.001), adjacent organ involvement (95%CI: 0.758~0.832; P<0.001), depth of invasion (95%CI: 1.360~1.407; P<0.001), lymph node metastasis (95%CI:1.302~1.329; P<0.001), total number of lymph nodes (95%CI: 0.667~0.696; P<0.001) and metastasis (95%CI: 3.055~3.211; P<0.001) were available independent prognostic factors through multivariate analysis.

Conclusions

With the increase of TNM stage, the overall survival rate of patients with colorectal cancer undergoing radical surgery was gradually reduced. However, compared the prognosis of ⅡA、ⅡB、ⅡC with that of ⅢA、ⅢB, primary tumor invasion depth (T grading) may be more important than the number of lymph node metastasis (N grading) in predicting the prognostic value. In addition, the factors of sex, years of diagnosis, race, primary site, pathological grading, adjacent organ involvement, depth of invasion, lymph node metastasis, total number of lymph nodes and metastasis were available independent prognostic factors. This provided reference for the analysis of the prognosis of patients with colorectal cancer.

Key words: Colorectal neoplasms, Prognosis, TNM classification, Survival

Weigang Zhang, Yanyan Zhang, Xianwen Zhang, Shifeng Teng, Houshan Yao, Xinxing Li, Zhiqian Hu. Prognosis factor of patients with colorectal cancer: a retrospective study of surveillance, epidemiology, and end results population-based data[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2017, 06(01): 21-27.

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References 17

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分期		总例数（87 885）	5年生存率（%）
Ⅰ		17 311	81.2
?	ⅠA	6 503	84.7
?	ⅠB	10 808	79.0
Ⅱ		28 331	71.7
?	ⅡA	24 900	73.6
?	ⅡB	1 754	60.1
?	ⅡC	1 677	54.6
Ⅲ		28 793	58.4
?	ⅢA	3 216	78.7
?	ⅢB	19 005	61.5
?	ⅢC	6 572	39.5
Ⅳ		13 450	14.4

分期		总例数（87 885）	5年生存率（%）
Ⅰ		17 311	81.2
?	ⅠA	6 503	84.7
?	ⅠB	10 808	79.0
Ⅱ		28 331	71.7
?	ⅡA	24 900	73.6
?	ⅡB	1 754	60.1
?	ⅡC	1 677	54.6
Ⅲ		28 793	58.4
?	ⅢA	3 216	78.7
?	ⅢB	19 005	61.5
?	ⅢC	6 572	39.5
Ⅳ		13 450	14.4

临床病理因素		5年生存率（%）	单因素分析		多因素分析
临床病理因素		5年生存率（%）	Log rank χ² test	P值	HR	95%CI	P值
性别		?	5.662	0.017	0.978	0.958~0.997	0.025
?	男性	59.9	?	?	?	?	?
?	女性	60.9	?	?	?	?	?
诊断年龄		?	1.348	0.246	?	?	-
?	<60	60.6	?	?	?	?	?
?	≥60	60.3	?	?	?	?	?
诊断年份		?	100.476	<0.001	0.979	0.967~0.992	0.001
?	2004~2005	58.3	?	?	?	?	?
?	2006~2007	60.7	?	?	?	?	?
?	2008~2009	62.1	?	?	?	?	?
人种		?	227.960	<0.001	0.927	0.912~0.942	<0.001
?	白种人	60.6	?	?	?	?	?
?	黑种人	55.2	?	?	?	?	?
?	其他	65.4	?	?	?	?	?
?	未知	75.2	?	?	?	?	?
肿瘤部位		?	457.809	<0.001	0.904	0.896~0.912	<0.001
?	右半结肠	57.5	?	?	?	?	?
?	横结肠	58.6	?	?	?	?	?
?	左半结肠	62.2	?	?	?	?	?
?	直肠	65.5	?	?	?	?	?
?	结肠未特指	50.6	?	?	?	?	?
分化程度		?	2 364.001	<0.001	1.183	1.162~1.204	<0.001
?	高分化	71.6	?	?	?	?	?
?	中分化	63.1	?	?	?	?	?
?	低分化	47.1	?	?	?	?	?
?	未分化	44.9	?	?	?	?	?
邻近器官有无受累		?	3 475.630	<0.001	0.794	0.758~0.832	<0.001
?	无	62.6	?	?	?	?	?
?	有	30.1	?	?	?	?	?
浸润深度（T）		?	8 281.813	<0.001	1.383	1.360~1.407	<0.001
?	T1	83.4	?	?	?	?	?
?	T2	77.1	?	?	?	?	?
?	T3	58.9	?	?	?	?	?
?	T4a	36.8	?	?	?	?	?
?	T4b	30.1	?	?	?	?	?
阳性淋巴结数（N）		?	12 034.484	<0.001	1.315	1.302~1.329	<0.001
?	0（N0）	72.9	?	?	?	?	?
?	1~3（N1）	55.6	?	?	?	?	?
?	4~6（N2a）	40.0	?	?	?	?	?
?	≥7（N2b）	25.8	?	?	?	?	?
检出淋巴结数		?	362.497	<0.001	0.681	0.667~0.696	<0.001
?	<12	56.4	?	?	?	?	?
?	≥12	62.2	?	?	?	?	?
是否远处转移（M）		?	23 960.974	<0.001	3.132	3.055~3.211	<0.001
?	M0	68.7	?	?	?	?	?
?	M1	14.4	?	?	?	?	?

临床病理因素		5年生存率（%）	单因素分析		多因素分析
临床病理因素		5年生存率（%）	Log rank χ² test	P值	HR	95%CI	P值
性别		?	5.662	0.017	0.978	0.958~0.997	0.025
?	男性	59.9	?	?	?	?	?
?	女性	60.9	?	?	?	?	?
诊断年龄		?	1.348	0.246	?	?	-
?	<60	60.6	?	?	?	?	?
?	≥60	60.3	?	?	?	?	?
诊断年份		?	100.476	<0.001	0.979	0.967~0.992	0.001
?	2004~2005	58.3	?	?	?	?	?
?	2006~2007	60.7	?	?	?	?	?
?	2008~2009	62.1	?	?	?	?	?
人种		?	227.960	<0.001	0.927	0.912~0.942	<0.001
?	白种人	60.6	?	?	?	?	?
?	黑种人	55.2	?	?	?	?	?
?	其他	65.4	?	?	?	?	?
?	未知	75.2	?	?	?	?	?
肿瘤部位		?	457.809	<0.001	0.904	0.896~0.912	<0.001
?	右半结肠	57.5	?	?	?	?	?
?	横结肠	58.6	?	?	?	?	?
?	左半结肠	62.2	?	?	?	?	?
?	直肠	65.5	?	?	?	?	?
?	结肠未特指	50.6	?	?	?	?	?
分化程度		?	2 364.001	<0.001	1.183	1.162~1.204	<0.001
?	高分化	71.6	?	?	?	?	?
?	中分化	63.1	?	?	?	?	?
?	低分化	47.1	?	?	?	?	?
?	未分化	44.9	?	?	?	?	?
邻近器官有无受累		?	3 475.630	<0.001	0.794	0.758~0.832	<0.001
?	无	62.6	?	?	?	?	?
?	有	30.1	?	?	?	?	?
浸润深度（T）		?	8 281.813	<0.001	1.383	1.360~1.407	<0.001
?	T1	83.4	?	?	?	?	?
?	T2	77.1	?	?	?	?	?
?	T3	58.9	?	?	?	?	?
?	T4a	36.8	?	?	?	?	?
?	T4b	30.1	?	?	?	?	?
阳性淋巴结数（N）		?	12 034.484	<0.001	1.315	1.302~1.329	<0.001
?	0（N0）	72.9	?	?	?	?	?
?	1~3（N1）	55.6	?	?	?	?	?
?	4~6（N2a）	40.0	?	?	?	?	?
?	≥7（N2b）	25.8	?	?	?	?	?
检出淋巴结数		?	362.497	<0.001	0.681	0.667~0.696	<0.001
?	<12	56.4	?	?	?	?	?
?	≥12	62.2	?	?	?	?	?
是否远处转移（M）		?	23 960.974	<0.001	3.132	3.055~3.211	<0.001
?	M0	68.7	?	?	?	?	?
?	M1	14.4	?	?	?	?	?

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