Multivariate Analysis Of Prognosis Of Elderly Rectal Cancer After Chemotherapy

BackgroudRectal cancer (carcinoma of rectum) is one of clinical common malignant tumor of digestive tract, ranking gastrointestinal malignant tumor in 3rd place, accounting for about 26% of cancers of the gastrointestinal tract, accounting for more than 60% of the colorectal cancer. Every year around the world has more than 80 million new cases, and with the rising trend in recent years, the mortality rate as high as 60%. Prognosis of rectal cancer is affected by many factors, which patient sex, age, tumor size, pathological stage, histological grading, whether intestinal obstruction or perforation, lymph node status, there is no vascular invasion and Bcl-2, vascular endothelial growth factor (VEGF) expression levels are closely related with the prognosis of rectal cancer. Tumor markers (tumor marker) is that can reflect the state of the tumor of the chemical substances and provide guidance on the basis of the existed in embryonic tissues and does not exist or rarely in normal tissue expression, which shows significantly higher expression levels in tumor tissue, this kind of material can effectively prompt the tumor and the nature of the state, so as to the diagnosis, treatment and prognosis of tumor. More and more studies show that the detection of carcinoembryonic antigen CEA and CA199 can be used as an important indicator of the pathogenesis and diagnosis of rectal cancer.ObjectiveEarly on the relevant factors of the relapse of the understanding and analysis can provide guidance for the prediction of prevention and treatment and prognosis of colorectal cancer, with the effective early intervention to improve the survival of patients. This study select 100 cases of elderly rectal cancer patients in our hospital, to analyze the factors affecting the prognosis and to explore pathological characteristics related to the postoperative adjuvant chemotherapy, so as to provide a theoretical basis for the treatment of clinical colorectal carcinoma in elderly patients, and accurate prediction of the prognosis of the patients.Method1. Clinical data of 100 cases of elderly rectal cancer patients in our hospital in January 2007 to January 2010 were selected and to analyze the basic information, tumor situation, surgery and adjuvant therapy, tumor markers and postoperative recurrence and metastasis.2 Using the chemiluminescence immunoassay to detect the expression level of serum CEA and CA199.3. Using the Kaplan Meier method calculated rectal cancer survival rate after resection and making single factor analysis to determine the risk factors, which influencing the prognosis of rectal cancer was analyzed by Cox regression model for multivariate regression analysis.Result1.100 cases of elderly patients with rectal cancer undergoing surgery,3 years disease-free survival rate was 74.0%(74/100),5 years tumor free survival rate was 72.0%(72/100).2. The rectal cancer prognostic factors of elderly patients were analyzed by Kaplan Meier univariate analysis showed that patients gender, age, tumor location, the dentate line distance, cutting edge distance as well as the type of operation had no significant correlation with the prognosis, and tumor diameter, tumor differentiation degree, histological grade, lymph node metastasis, TNM stage, invasion degree, preoperative CEA and CA199 expression level and whether the use of adjuvant chemotherapy in the treatment patients were risk factors affecting the prognosis of the patients.3. Adjuvant chemotherapy can effectively improve the prognosis of the patients with preoperative CEA> 1 Ong/mL, CA199> 37U/mL.4. The factors affecting on prognosis of elderly patients with rectal cancer after the single factor analysis by using multivariate Cox regression showed that, tumor size, TNM stage, lymph node metastasis, tumor differentiation degree and preoperative CEA expression level were independent risk factor for influencing the prognosis of patients.5. The Kaplan Meier method and Long-Rank method calculated and compared the survival rates showed that, patients with lymph node metastasis, TNM staging III, preoperative CEA> 10 ng/mL, using postoperative adjuvant chemotherapy can significantly improve the 3,5 years survival rate than that in non chemotherapy group, the difference was statistically significant (P< 0.05).Conclusion1. Tumor diameter>5cm, low tumor differentiation, TNM stage III lymph node metastasis and preoperative CEA> 10 ng/mL were independent risk factors influencing the prognosis of patients and which can be used as a reference for future prognosis.2 The patients with high-risk factors of lymph node metastasis and preoperative CEA > 10ng/mL can be considered adjuvant chemotherapy after operation.