大腸直腸癌存活與相關預測因子探討

Survival and related predictive factors of colorectal cancer

目的：從癌症登記資料庫2007年至2013年期間大腸直腸癌新診斷個案892人進行統計分析，探討大腸直腸癌存活與相關預測因子。方法：以台灣某醫學中心2007年至2013年期間大腸直腸癌新診斷個案892人，本研究為回顧性研究，使用Kaplan-Meier存活率分析及Cox迴歸模型單變項分析，再經Cox向前逐步迴歸分析大腸直腸癌存活率與相關預測因子。結果：本研究大腸直腸癌第一期為195人（21.86%）、第二期為245人（27.47%）、第三期為307人（34.42%）、第四期為145人（16.26%）；平均存活時間（月）為84.40、75.80、68.92、35.59，整體平均存活時間為70.78。透過Cox迴歸模型分析結果，發現罹病年齡、區域淋巴轉移狀態、病理組織類型、KRAS檢查值等均顯示（p<.05）是大腸直腸癌個案存活的預測因子。結論：本研究結果顯示，會影響大腸直腸癌個案較低存活率之相關預測因子如下：罹病年齡、腫瘤侵犯程度（T）、區域淋巴轉移狀態（N）、遠端器官轉移（M）、病理期別（Stage）、病理組織類型、病理組織分化（Grade）、原發腫瘤大小、病理環切緣（CRM）、周邊神經侵犯（PN）、KRAS檢查值、腸阻塞、腸穿孔等，因此民眾若能早期診斷早期治療即可提高存活率。

Objective: To look into statistically 892 new cases of colorectal cancer recorded in 2007 to 2013 and find out their survival time periods and relevant predictors. Methods: This study was carried out on cases diagnosed at one certain medical center in Taiwan during the seven-year period. In this study, Kaplan-Meier survival analysis and Cox regression model were used for the retrospective study. The survival time and related predictors of this particular cancer among those specimens were calculated by a stepwise regression analysis. Results: At the time of diagnosis, 195 cases (21.86% of the total) were classified as in the first phase of such cancer, whereas 245 cases (27.47%) in the second phase is, 307 cases (34.42%) in the third phase, and 145 (16.26%) in the fourth phase. Their individual survival time periods (in months) were 84.40, 75.70, 68.55, and 34.45 respectively. The average overall survival time period was 70.22 months. The results of Cox regression model showed that morbidity, regional lymphatic metastasis, pathological type, and KRAS are all significant (p<.05) as predictors of the survival of colorectal cancer. Conclusions: The results of this study show that the predictors of lowering survival rates of patients with colorectal cancer are as follows: age of the patient, degree of tumor invasion (T), regional lymphatic metastasis (N), distal organ metastasis (M), pathological term (Sage), pathological type, histopathological grading (Grade), size of original tumor, pathological ring cut edge (CRM), peripheral nerve invasion (PN), KRAS examination, intestinal obstruction, intestinal perforation, etc. Therefore, in short, people can improve survival time period of this very disease by undertaking earlier diagnosis and medical treatments.