外科理论与实践 ›› 2022, Vol. 27 ›› Issue (04): 340-345.doi: 10.16139/j.1007-9610.2022.04.013
收稿日期:
2020-05-14
出版日期:
2022-07-25
发布日期:
2022-09-20
通讯作者:
李幼生
E-mail:guttx@hotmail.com
基金资助:
CHENG Wei, HUANG Yuhua, WANG Jian, LI Yousheng()
Received:
2020-05-14
Online:
2022-07-25
Published:
2022-09-20
Contact:
LI Yousheng
E-mail:guttx@hotmail.com
摘要:
目的:多因素分析影响癌性肠梗阻(malignant bowel obstruction, MBO)病人预后的危险因素,构建MBO病人生存期预测的列线图模型。方法:回顾性分析我院2013年6月至2019年6月 203例MBO病人的临床资料及随访。结果:随访143例(70.4%)病人。单因素分析结果显示,性别、年龄、血小板、C反应蛋白、总蛋白含量、合并症数量、使用生长抑素治疗、肠内营养和肠外营养治疗、住院时间与MBO病人的生存无相关性。肿瘤TNM分期晚(P<0.001)、肿瘤继发转移(P<0.001)、贫血(P=0.001)、低白蛋白(P<0.001)、高白细胞(P=0.023)、非手术治疗(P=0.013)、生活质量评分低(P<0.001)以及肝功能差[包括高丙氨酸转氨酶(P=0.023)、高天冬氨酸转氨酶(P=0.005)]等因素与预后差有关。多因素分析显示,肿瘤分期(P=0.003)、白蛋白水平(P=0.001)是影响MBO病人预后的独立危险因素。采用TNM晚期、继发肿瘤以及血红蛋白低和白蛋白低4个指标构建的列线图。通过40例病人3~12个月的内部预测生存期,结果良好。结论:构建列线图和预后分析显示,MBO病人不良的主要因素是肿瘤晚期以及全身营养不良。
中图分类号:
程威, 黄雨桦, 王剑, 李幼生. 影响癌性肠梗阻病人预后的多因素分析[J]. 外科理论与实践, 2022, 27(04): 340-345.
CHENG Wei, HUANG Yuhua, WANG Jian, LI Yousheng. Multivariate analysis of prognosis of patients with malignant bowel obstruction[J]. Journal of Surgery Concepts & Practice, 2022, 27(04): 340-345.
表2
与癌性肠梗阻预后相关因素的单因素Cox回归分析
指标 | 病例数 | 危险比 | 95%CI | P值 |
---|---|---|---|---|
性别 | 143 | 0.727 | 0.469~1.126 | 0.153 |
年龄 | 143 | 1.003 | 0.989~1.017 | 0.679 |
TNM分期 | 127 | 3.768 | 2.346~6.025 | <0.001 |
原发或继发转移 | 143 | 3.506 | 2.230~5.514 | <0.001 |
白细胞 | 143 | 1.050 | 1.090~1.012 | 0.023 |
红细胞 | 143 | 0.584 | 0.436~0.783 | <0.001 |
血小板 | 143 | 0.999 | 0.997~1.001 | 0.168 |
血红蛋白 | 143 | 0.985 | 0.976~0.994 | 0.001 |
CRP | 57 | 1.003 | 0.998~1.010 | 0.235 |
ALT | 143 | 1.006 | 1.001~1.010 | 0.023 |
AST | 143 | 1.002 | 1.001~1.003 | 0.005 |
总蛋白 | 143 | 0.984 | 0.961~1.007 | 0.175 |
白蛋白 | 143 | 0.924 | 0.891~0.958 | <0.001 |
前白蛋白 | 138 | 0 | 0.001~0.002 | <0.001 |
合并慢性病数量 | 143 | 1.133 | 0.860~1.492 | 0.376 |
生长抑素 | 143 | 0.961 | 0.594~1.553 | 0.870 |
肠内营养 | 143 | 0.810 | 0.439~1.496 | 0.501 |
肠外营养 | 143 | 0.715 | 0.440~1.161 | 0.175 |
住院时间 | 143 | 0.999 | 0.983~1.014 | 0.879 |
是否手术 | 143 | 0.522 | 0.312~0.870 | 0.013 |
生活质量评分 QOL | 143 | 0.860 | 0.883~0.887 | <0.001 |
ZPS | 143 | 8.672 | 5.440~13.826 | <0.001 |
KPS | 143 | 0.916 | 0.899~0.934 | <0.001 |
表3
与癌性肠梗阻预后相关因素的多因素Cox回归分析
变量 | 回归系数 | 标准误 | 危险比 | 95%CI | P值 |
---|---|---|---|---|---|
TNM分期 | 0.838 | 0.281 | 2.312 | 1.331~4.015 | 0.003 |
原发或继 发转移 | 0.544 | 0.350 | 1.723 | 0.867~3.423 | 0.120 |
血红蛋白 | -0.005 | 0.006 | 0.995 | 0.985~1.006 | 0.395 |
白蛋白 | -0.076 | 0.023 | 0.927 | 0.886~0.970 | 0.001 |
ALT | 0.002 | 0.006 | 1.002 | 0.989~1.015 | 0.762 |
AST | 0.001 | 0.002 | 1.001 | 0.996~1.005 | 0.795 |
是否手术 | -0.090 | 0.284 | 0.914 | 0.524~1.594 | 0.752 |
[1] |
Jacquet P, Jelinek JS, Steves MA, et al. Evaluation of computed tomography in patients with peritoneal carcinomatosis[J]. Cancer, 1993, 72(5):1631-1636.
pmid: 8348494 |
[2] |
Ripamonti C, Twycross R, Baines M, et al. Clinical-practice recommendations for the management of bowel obstruction in patients with end-stage cancer[J]. Support Care Cancer, 2001, 9(4):223-233.
pmid: 11430417 |
[3] |
Selby D, Wright F, Stilos K, et al. Room for improvement? a quality-of-life assessment in patients with malignant bowel obstruction[J]. Palliat Med, 2010, 24(1):38-45.
doi: 10.1177/0269216309346544 pmid: 19797338 |
[4] | Krouse RS. The international conference on malignant bowel obstruction: a meeting of the minds to advance palliative care research[J]. J Pain Symptom Manage, 2007, 34(1 Suppl):S1-S6. |
[5] |
Kim JS, Hur H, Min BS, et al. Oncologic outcomes of self-expanding metallic stent insertion as a bridge to surgery in the management of left-sided colon cancer obstruction: comparison with nonobstructing elective surgery[J]. World J Surg, 2009, 33(6):1281-1286.
doi: 10.1007/s00268-009-0007-5 URL |
[6] |
Ansaloni L, Andersson RE, Bazzoli F, et al. Guidelenines in the management of obstructing cancer of the left colon: Consensus Conference of the World Society of Emergency Surgery (WSES) and Peritoneum and Surgery (PnS) Socie-ty[J]. World J Emerg Surg, 2010, 5:29.
doi: 10.1186/1749-7922-5-29 pmid: 21189148 |
[7] |
Morris EJ, Taylor EF, Thomas JD, et al. Thirty-day postoperative mortality after colorectal cancer surgery in England[J]. Gut, 2011, 60(6):806-813.
doi: 10.1136/gut.2010.232181 pmid: 21486939 |
[8] |
Krouse RS. Malignant bowel obstruction[J]. J Surg Oncol, 2019, 120(1):74-77.
doi: 10.1002/jso.25451 URL |
[9] |
Ho KM, Chan KM, Kwok SY, et al. Colonic self-expan-ding metal stent (SEMS) as a bridge to surgery in left-sided malignant colonic obstruction: an 8-year review[J]. Surg Endosc, 2017, 31(5):2255-2262.
doi: 10.1007/s00464-016-5227-9 URL |
[10] |
Rodrigues-Pinto E, Morais R, Coelho C, et al. Bridge-to-surgery versus emergency surgery in the management of left-sided acute malignant colorectal obstruction - efficacy, safety and long-term outcomes[J]. Dig Liver Dis, 2019, 51(3):364-372.
doi: 10.1016/j.dld.2018.11.006 URL |
[11] | Anthony T, Baron T, Mercadante S, et al. Report of the clinical protocol committee: development of randomized trials for malignant bowel obstruction[J]. J Pain Symptom Manage, 2007,(1 Suppl):S49-S59. |
[12] | 顾晋. 肿瘤性肠梗阻的诊断和治疗[J]. 中国实用外科杂志, 2008, 28(9):703-706. |
[13] | Tuca A, Guell E, Martinez-Losada E, et al. Malignant bowel obstruction in advanced cancer patients: epidemio-logy, management, and factors influencing spontaneous resolution[J]. Cancer Manag Res, 2012, 4:159-169. |
[14] |
Arezzo A, Balague C, Targarona E, et al. Colonic stenting as a bridge to surgery versus emergency surgery for malignant colonic obstruction: results of a multicentre randomised controlled trial(ESCO trial)[J]. Surg Endosc, 2017, 31(8):3297-3305.
doi: 10.1007/s00464-016-5362-3 URL |
[15] |
Hoppenot C, Peters P, Cowan M, et al. Malignant bowel obstruction due to uterine or ovarian cancer: are there differences in outcome?[J]. Gynecol Oncol, 2019, 154(1):177-182.
doi: S0090-8258(19)31183-7 pmid: 31056111 |
[16] |
Frago R, Ramirez E, Millan M, et al. Current management of acute malignant large bowel obstruction: a systematic review[J]. Am J Surg, 2014, 207(1):127-138.
doi: 10.1016/j.amjsurg.2013.07.027 URL |
[17] | 江志伟, 黎介寿, 李宁, 等. 奥曲肽治疗晚期癌性肠梗阻的作用[J]. 医学研究生学报, 2007, 20(10):1044-1046. |
[18] |
Currow DC, Quinn S, Agar M, et al. Double-blind, placebo-controlled, randomized trial of octreotide in malignant bowel obstruction[J]. J Pain Symptom Manage, 2015, 49(5):814-821.
doi: 10.1016/j.jpainsymman.2014.09.013 URL |
[19] |
Mercadante S. Octreotide for malignant bowel obstruction: commentary on Currow et al[J]. J Pain Symptom Manage, 2015, 49(5):813.
doi: 10.1016/j.jpainsymman.2015.04.001 URL |
[20] |
Chi DS, Phaeton R, Miner TJ, et al. A prospective outcomes analysis of palliative procedures performed for malignant intestinal obstruction due to recurrent ovarian cancer[J]. Oncologist, 2009, 14(8):835-839.
doi: 10.1634/theoncologist.2009-0057 URL |
[21] | Cousins SE, Tempest E, Feuer DJ. Surgery for the resolution of symptoms in malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer[J]. Cochrane Database Syst Rev, 2016(1):CD002764. |
[22] | Bento JH, Bianchi ET, Tustumi F, et al. Surgical ma-nagement of malignant intestinal obstruction: outcome and prognostic factors[J]. Chirurgia (Bucur), 2019, 114(3):343-351. |
[23] |
Baumgartner JM, Marmor R, Hsu A, et al. Obstruction-free survival following operative intervention for malignant bowel obstruction in appendiceal cancer[J]. Ann Surg Oncol, 2019, 26(11):3611-3617.
doi: 10.1245/s10434-019-07507-4 pmid: 31190209 |
[24] |
Stein SL. Expert commentary on malignant bowel obstruction[J]. Dis Colon Rectum, 2019, 62(9):1031-1032.
doi: 10.1097/DCR.0000000000001447 URL |
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