作者：吴勇金1，薛天慧2，颜兵2

单位：1.三亚中心医院（海南省第三人民医院） 普通外科二病区，海南 三亚 572000；2.解放军总医院海南医院 肿瘤科，海南 三亚 572000

Authors: Wu Yongjin1， Xue Tianhui2，Yan Bing2

Unit: 1.Department of General Surgery Unit 2, Sanya Central Hospital （Hainan Third People’s Hospital）, Sanya 572000，Hainan，China；2.Department of Oncology, Hainan Hospital of Chinese PLA General Hospital, Sanya 572000, Hainan, China

摘要：

目的 探讨术后辅助化疗总延迟（TDAC）对结直肠癌（CRC）患者3年无病生存（DFS期的影响。方法 回顾性收集解放军总医院海南医院2012年12月至2020年12月经手术根治后合并高危因素的Ⅱ期或Ⅲ期结直肠癌且术后至少接受3个月辅助化疗的患者111例，计算TDAC并分析其对DFS的预测价值。将患者分为TDAC低组或TDAC高组，计算两组不同临床参数的差异并分析两组DFS的不同，通过Cox比例风险模型计算影响DFS的危险因素。结果 以30.50 d为界，TDAC对患者DFS具有预测价值（曲线下面积为0.64,P=0.02），其敏感性为41.30%，特异性为86.20%。两组患者性别、组织学分化程度、是否存在黏液成分等参数差异均有统计学意义（均P=0.05）。TDAC低组患者DFS明显优于TDAC高组（Log rank=8.91,P<0.01）。TDAC是影响DFS的独立危险因素之一（HR=2.12,95%CI:1.17～3.86,P=0.01）。结论 TDAC是辅助判断合并高危因素的Ⅱ期或Ⅲ期CRC患者预后的指标之一；TDAC-低组患者DFS优于TDAC-高组且其是患者预后的独立危险因素之一。

关键词：结直肠癌；辅助化疗；延迟；无病生存期

Abstract：

Objective To explore the value of post-operation total delay of adjuvant chemotherapy（TDAC） in predicting the 3 years disease free survival （DFS） in colorectal cancer （CRC）. Method 111 patients after radical surgery （staged Ⅱ accompanied with high risk factor or staged Ⅲ ） and received at least 3 months adjuvant chemotherapy were retrospectively collected between December 2012 to December 2020 in Hainan Hospital of Chinese PLA General Hospital. The value of TDAC in predicting DFS was tested and patients were divided into TDAC-low or -high subgroups. The differences of the clinical features as well as DFS in these subgroups were examined. A Cox proportional hazard model was used to test the risk factors for survival. Result Taken 30.50 days as the cut -off point, TDAC was significant in predicting the DFS（area under the curve: 0.64, P =0.02） with a sensitivity at 41.30% and a specificity at 86.20% . Gender, histopathological differentiation, with or without mucinous element were significant different in TDAC-low or-high subgroups （all P=0.05）. Patients in TDAC-low group would have significant better DFS than the high ones （Log rank=8.91, P＜0.01）. TDAC was one of an independent risk factors for DFS （HR=2.12, 95%CI:1.17～3.86, P=0.01）. Conclusion TDAC was a useful predictor for CRC patients accompanied with high risk factor in stage Ⅱ or stage Ⅲ; patients with a relative low TDAC would have a superior survival than the high ones and TDAC was one of an independent risk factor for prognosis.

Key Words: Colorectal cancer；Adjuvant chemotherapy；Delay；Disease free survival