Abstract: Objective:To investigate the related factors affecting prognosis of patients with colorectal cancer undergoing palliative resection.
Methods:The clinical data of 345 patients with colorectal cancer who underwent palliative resection at the First Affiliated Hospital of Guangxi Medical University between January 2007 and December 2011 were retrospectively analyzed. Patients selected the emergent operations or restrictive operation based on the conditions of patients, and then received chemotherapy, radiotherapy and biotherapy. Chemotherapy regimens included FOLFOX4 (5FU/CF+ oxaliplatin) regimen, XELOX (capecitabine+oxaliplatin) regimen and FOLFIRI (5FU+CF+irinotecan) regimen. Biotherapy regimens included molecular targeted therapies using bevacizumab and cetuximab. The followup was applied to patients by outpatient examination, telephone interview and correspondence once every 3 months up to March 1, 2014. The survival curve was drawn by the KaplanMeier method. The survival rate was analyzed using the Log rank test. The multivariate analysis was done using the COX regression model.
Results:Of the 1 930 patients, 345 patients received palliative resection with a percentage rate of 17.876%. Among the 345 patients, 104 patients received emergent operations and others received restrictive operations. After operation, 178 patients received adjuvant treatment, FOLFOX4 regimens were done on 85 patients, XELOX regimens on 32 patients, FOLFIRI regimens on 20 〖HJ〗patients, radiotherapy on 17 patients and molecular targeted therapies on 24 patients. Seven patients died in the perioperative period and other patients were followed up for 3.0-82.0 months with a median time of 14.0 months. The 1, 3 and 5year survival rates and the mean survival time were 49.57%, 11.88%, 6.38% and 22.6 months, respectively. The results of univariate analysis showed that the CEA levels ,bowel obstruction, primary tumor resection, peritoneal implantation, distal metastasis, lymph node metastasis, tumor differentiation, postoperative adjuvant therapy were related factors affecting the prognosis of patients undergoing palliative resection (χ²=3.742, 18.795, 37.641, 13.470, 4.228, 5.835, 4.108, 6.875, P<0.05). The results of multivariate analysis showed that the bowel obstruction, without primary tumor resection, peritoneal implantation, lowdifferentiation of tumor and without postoperative adjuvant therapy were the independent risk factors affecting the prognosis of patients undergoing palliative resection (RR= 1.674, 2.273, 1.947, 1.582, 1.342, 95% confidence interval: 1.193- 2.485, 1.646-4.376, 1.497-3.587, 1.184-2.382, 1.03²-2.074, P<0.05).
Conclusion:The lowdifferentiation of tumor, peritoneal implantation, bowel obstruction, without primary tumor resection and without postoperative adjuvant therapy are the independent risk factors affecting the prognosis of patients with colorectal cancer undergoing palliative resection.