根治术大肠癌预后因素和个体预后预测模型的研究

杨艳芳; 李佩珍; 梁小波; 韩晓立; 李耀平; 丛娟

Abstract

杨艳芳,李佩珍,梁小波,韩晓立,李耀平,丛娟.根治术大肠癌预后因素和个体预后预测模型的研究[J].Chinese journal of Epidemiology,2005,26(3):214-217

根治术大肠癌预后因素和个体预后预测模型的研究

Study on the prognostic factors of colorectal cancer after radical resection and on suggested model for prediction??

Received:July 29, 2004

DOI：

KeyWord: 大肠癌预后 Cox模型

English Key Word: Colorectal cancer Prog nosis Cox model

FundProject:山西省自然科学基金资助项目(991076)

Author Name	Affiliation	E-mail
YANG Yan-fang	Department of Epidemiology,Shanxi Medical University,Taiy uan 030001, China
LI Pei-zhen	Department of Epidemiology,Shanxi Medical University,Taiy uan 030001, China	lipz228@sina.com.cn
LIANG Xiao-bo	Department of Epidemiology,Shanxi Medical University,Taiy uan 030001, China
HAN Xiao-li	山西省肿瘤医院
LI Yao-ping	山西省肿瘤医院
Cong Juan	山西省肿瘤医院

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Abstract:

目的　寻找影响大肠癌患者根治术后生存的预后因素。方法　选取根治术大肠癌原发病例120例,查阅病历及5年以上随访资料。并取病例的存档石蜡块,切片后进行 SP免疫组化方法检测p53、C-erbB-2、nm23-H₁、Ras四个基因蛋白表达物。结果　p53、C-erbB-2、Ras、nm23-H₁ 蛋白在120例大肠癌组织中阳性表达率分别为62.5%(75/120)、25.8%(31/120)、80.0%(96/120)、60.8%(73/120)。将分子生物学标志物与临床病理指标相结合,经Cox单因素分析,在α=0.05水平,结果显示:肿瘤大体分型、组织学分级、浸润深度、淋巴结转移、Dukes’分期、p53、Ras、nm23 H1 为有意义的预后影响因素(P<0.05)。Cox多因素分析结果显示,在α=0.05水平,Dukes’分期、p53、nm23-H₁ 是影响大肠癌患者预后的独立指标(P=0.000),其 RR 值分别为3.06、6.02、0.40。由此建立的预后预测模型为:h(t,x)=h₀(t)exp(- 0. 9269X₁₄+ 1.1197X₁₀+ 1.7948X₁₁),其预测预后的灵敏度为79.1%,特异度为83.0%,符合率为80.8%,Kappa值为0.62。结论　Dukes’分期、p53、nm23-H₁ 是影响大肠癌患者根治术后生存重要的预后指标,由此建立的预后预测模型具有较高的信度和效度,可为临床医师对大肠癌患者个体预后结局估计提供有力的工具。

English Abstract:

ObjectiveTo study the factors of colorectal cancer ( CRC ) after radical resection to provide data pr edicting the prognosis of the patients. Methods ?? 120 cases of CRC were collected in this study. Medical clinical recor ds and 5??year follow??updata were reviewed. Streptavidin??peroxidase immuno histochemical technique was used to detect the ex pression of p53, C-erbB-2, nm23-H₁ and Ras on ormalin??fixed, paraffin embedded sections of CRC from the 120 patients. Results Results showed that therates of positive expression of p53, C-erbB-2, Ras and nm23-H₁ were 62. 5%( 75/ 120),25. 8%( 31/ 120),80.0%( 96/120) and 60.8%(73/120)respectively in the CRC tissue. All pathological variables and biolog ical markers were analyzed with Cox regression model (α=0.05).Eight distinguished prognostic factors were identified in the univariate analysis as: macroscopic configuration, histology grade, depth of invasion of intestinal, lymph nodes metastasis, Dukes'classification, p53, Ras and nm23-H₁. The Results of multivariate analysis(α=0.05) indicated that the independent prognostic factors were Dukes'classification,p53 and nm23-H₁(P=0.000),with relative risk of 3.06,6.02 and 0.40, respectively.A prognostic model: h(t,x)= h₀(t)exp(-0.9269X₁₄ + 1.1197 X₁₀+ 1.7948 X₁₁ ) was established. Sensitivity,specificity agreement and reliability of the model and Kappa w ere 79. 1%, 83. 0%, 80. 8% and 0. 62,respectively. Conclusion Dukes'classification, p53 and nm23-H₁ seemed to be independent and important prognostic factors. This prognostic model could be used to evaluate the prognosis of patients with CRC by clinicians.

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