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Survival Analyses in Colorectal Carcinoma in Xiaoshan District

Author: WangFenJuan
Tutor: ChenKun
School: Zhejiang University
Course: Public Health
Keywords: Colorectal Cancer Cancer patients Colon Cancer Stromal tumors Prognostic factors Survival analysis Age of onset Distant metastasis Prognostic factors Malignancies rectal Univariate analysis Histological grade carcinoma Death registration Lymph node metastasis Proportional hazards model Biomarker assays Tumor-infiltrating Metastatic lymph nodes
CLC: R735.3
Type: Master's thesis
Year: 2010
Downloads: 91
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Abstract


Colorectal cancer is a serious hazard to human health is one of the common malignant tumors. In western countries, colorectal cancer deaths after lung cancer in the second column. Living in our colorectal cancer mortality between the fourth to six, and showed an increasing trend. Although with the comprehensive treatment based on surgery carried out, the prognosis of patients with colorectal cancer has been greatly improved, but still only reached after the five-year survival 60-70%. A comprehensive assessment system that can guide clinical practice and save medical costs, but still used in the past are now classic clinical TNM staging for prognostic evaluation. With the development of science, particularly molecular biomarkers in large numbers, the establishment of a molecule based on individual characteristics and prognostic biomarker evaluation system is an urgent task. Xiaoshan District in the 1970s began to establish the cause of death registration reporting system tumors, and later established tumor incidence reporting system, it is the country earlier in the cancer incidence and death registration of the county (district) level one of the units, with a relatively well cancer incidence and cause of death information. We record linked to cancer, Xiaoshan District incidence and mortality monitoring system as the basis for taking rectal morbidity patterns and survival analysis. Where clinically diagnosed during the study period as colorectal cancer account the location of the new cases of Xiaoshan District, fill out a unified \coding, database entry. Incidence data from January 1990 to December 2005 confirmed cases of colorectal cancer, in order to carry out follow-up. Outcome data from all causes of death registration system, obtained by recording the coupling and remove the fundamental cause of death was non-colorectal cancer cases. No deaths occurred on-site follow-up to determine survival. Select the period 1991-2000 the complete archives of cases of colorectal cancer patients, review all medical records, access to clinical data, while excluding deaths within one month after surgery, and to remove the cause of death has nothing to do with the cases of colorectal cancer. 320 cases finalized cases were confirmed by surgery and pathology. Of which 101 cases of colon cancer, rectal cancer 219 cases; 183 cases of male, female 137 cases. Of which 226 cases underwent surgery, including 71 cases of colon cancer, rectal cancer 155 cases; 124 cases of male, female 102 cases. Follow-up deadline December 31, 2002, the shortest month follow-up period, the longest 152 months, with a median follow-up time of 45 months, with an average follow-up time of 52 months. Each case contains a representative selection of tumor tissue and normal tissue paraffin wax block sections were stained with HE and immunohistochemical staining Envsion France. Using SPSS 12.0 for windows for statistical analysis. Using the life table method to calculate the cumulative survival rate one year intervals; using Kaplan-Meier method for univariate survival analysis (Log-rank method with significant test), and draw the survival curve; using univariate COX proportional hazards model Univariate survival analysis, and calculate the OR values. The univariate analysis were statistically significant prognostic factors and then into the multivariate COX proportional hazards model analysis. Between the two indicators using X2 test was used for correlation analysis, and calculate the Spearman rank correlation coefficient. Xiaoshan District, 1991-2000 average annual incidence rate of colorectal cancer 11.55/10 Wan, accounting for 8.99% of all tumors, ranking fourth; straight, colon ratio of 1.80:1; colorectal cancer incidence with age rise and rise, high above the age of 45 years age group; male colorectal cancer incidence in women, male and female colorectal cancer incidence rates showed an upward trend, and the growth rate of women faster than men. This disease characteristics and disease trends consistent with domestic related reports. For the period 1990-2005 the incidence of cancer mortality analysis, age of onset of colorectal cancer patients with the diagnosis of time after the shift and increased between 2001-2005 than the age of onset of cases between 1996 and 2000, the same 1996 - cases higher than 2000 cases in 1991-1995, the age of onset of colorectal cancer than of colon cancer respectively (P lt; 0.05), gender and age at onset was not found relevant; diseased parts to cancer, accounting for 60.2% age, diagnosis period and diseased parts related to the age of 60 the incidence of colon cancer patients was higher than 60 age group, after 2000 the incidence of colon cancer patients is higher than the pre-2000 cases. Colorectal cancer patients a year, 3-year, 5-year survival rates were 51.5%, 45.6% and 43.4%. Affect prognosis of colorectal cancer are the main factors tumor (colon / rectum), age of onset and diagnosis period. Cancer, more than 60 years of age of onset and poor prognosis, while after 2000 patients with good prognosis. Respectively, occurred in 1991-2000, 101 cases of colon cancer and 219 cases of rectal cancer were retrospectively analyzed clinical pathology, on which 226 cases of patients after surgical treatment were further survival analysis, while 167 cases were tubular adenocarcinoma tumor buds with other clinicopathological parameters correlation analysis found that: colon and rectal cancer survival rates in different years; smoking, lymph node metastasis at diagnosis and serum albumin levels are prognostic factors of colon cancer; TNM staging, distant metastasis and rectal surgery program are prognostic factors; prognostic factors both in the presence of a significant difference. Radical surgery for colon cancer is higher than cancer, the recurrence rate is lower than rectal cancer, colon cancer prognosis which may be more to do with systemic conditions related causes. The prognosis of rectal cancer and the tumor itself are more and surgical treatment status. It is suggested that, in the clinical treatment and scientific research in the different treatment of colon cancer and rectal cancer. Through the 226 cases of surgical treatment in patients with clinical pathology and biomarker detection and analysis, found that five-year cumulative survival rate of colorectal cancer patients (67.42%), higher than the overall five-year cumulative survival rate (62.10%); surgery After the five-year cumulative survival rate of colon cancer (72.41%) higher than the five-year cumulative survival rate of cancer patients (65.24%). Multivariate analysis showed that patients with colorectal cancer prognostic factors include: age, perineural invasion, lymph node metastasis at diagnosis, distant metastasis, urine and P53 positive rate; postoperative cancer prognostic factors including tumor stroma lymphocytic infiltration, tumor buds, TNM stage and urine; postoperative colorectal cancer, lt; 40 years old and 40-60 years old there was no difference in survival between the only poor prognosis group ≥ 60 years of age. In related biomarkers and prognosis was found, P53 on the prognosis have a certain significance, and Ki67, Bc12 and CXCR4 no prognostic significance. In the postoperative rectal multivariate analysis, we also demonstrated that tumor buds is one of prognostic factors of tumor buds with other pathological correlation analysis showed that tumor budding and anatomical site, histological grade, depth of invasion, pulse vessel invasion, perineural invasion, tumor parenchyma lymphocyte infiltration, tumor interstitial infiltration of lymphocytes, Crohn-like reaction, the number of metastatic lymph nodes were significantly correlated. Survival analysis showed that while in colorectal adenocarcinoma tumor buds is an unfavorable prognostic factor. In summary, we can draw the following conclusions: First, the upward trend in the incidence of colorectal cancer, colorectal cancer incidence increased with age, high above the age of 45 years age group; high age of onset of colorectal cancer in the colon (P all lt; 0.05), diseased parts to cancer, accounting for 60.2%, two, age of onset of colorectal cancer patients in the increased incidence of proximal parts tend prognosis improving trend. Third, smoking, lymph node metastasis at diagnosis and serum albumin levels are unfavorable prognostic factors of colon cancer; TNM staging, distant metastasis and rectal surgery program is unfavorable prognostic factor; four postoperative adverse prognostic factor in colorectal cancer including: age, perineural invasion, lymph node metastasis at diagnosis, distant metastasis, urine and P53 positive rate; postoperative adverse prognostic factors include rectal tumor interstitial lymphocytic infiltration, tumor buds, TNM stage and urine; In the postoperative colorectal cancer, lt; 40 years old and 40-60 years old there was no difference in survival between the only poor prognosis group ≥ 60 years of age. Five, P53 on the prognosis have a certain significance, and Ki67, Bcl2 and CXCR4 no prognostic significance; six, tumor budding is a recommendable clinicopathological parameters.

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