结直肠癌肝和/或肺转移患者的预后影响因素分析:一项基于SEER数据库的回顾性研究

目的:分析初诊结直肠癌肝和/或肺转移患者的临床特点，探讨临床病理特征和预后之间的关系。方法:收集SEER数据库中2010年至2015年病理诊断为结直肠癌并伴有肝和/或肺转移的患者共21 845例，分为肝转移组、肺转移组以及肝和肺转移组。比较不同分组的临床病理特征，绘制生存曲线。采用单因素和多因素Cox回归模型分析预后影响因素。结果:肝转移组、肺转移组以及肝和肺转移组的基线特征均有统计学差异（P＜0.05），且中位生存期分别为18、21、11个月。多因素Cox显示:患者的年龄≥65岁、种族（黑种人vs白种人）、婚姻状况（单身/丧偶vs已婚）、肿瘤原发部位（横结肠/右半结肠vs左半结肠）、肿瘤分化等级（Ⅱ/Ⅲ/Ⅳ vs Ⅰ）、T分期（T4 vs T1）、N分期（N2/Nx vs N0）、肿瘤直径≥5 cm、淋巴结性质阳性、原发部位未手术、未接受放疗以及化疗、转移位置（肝和肺vs肝）是患者生存的独立危险因素（HR＞1，P＜0.05）。结论:转移位置是影响结直肠癌患者预后的重要危险因素，肺转移患者预后较好。根据肿瘤的临床病理特征来预测疾病进展趋势，有助于判断患者预后。

Prognostic factors of colorectal cancer patients with liver and/or lung metastasis:A retrospective study based on SEER database

Objective:To analyze the clinical features of colorectal cancer patients with liver and/or lung metastasis,and to explore the relationship between clinicopathological features and prognosis.Methods:A total of 21 845 patients with pathological diagnosis of colorectal cancer with liver and/or lung metastasis from 2010 to 2015 in SEER database were collected.They were divided into liver metastasis group,lung metastasis group,liver and lung metastasis group.The clinicopathological features of different groups were compared and the survival curve was drawn.Univariate and multivariate Cox regression models were used to analyze the prognostic factors.Results:The baseline features of liver metastasis group,lung metastasis group,liver and lung metastasis group were significantly different (P＜0.05),and the median survival time was 18,21 and 11 months respectively.Multivariate Cox analysis showed that patients' age ≥65 years old,race (black vs white),marital status (single/widowed vs married),primary tumor site (transverse colon/right-side colon vs left-side colon),tumor differentiation grade (Ⅱ/Ⅲ/Ⅳ vs Ⅰ),T-stage (T4 vs T1),N-stage (N2/Nx vs N0),tumor diameter ≥5 cm,positive lymph node nature,primary site not operated,not treated with radiotherapy and chemotherapy,metastatic location (liver and lung vs liver) were independent risk factors for survival (HR>1,P＜0.05).Conclusion:The location of metastasis is an important risk factor affecting the prognosis of colorectal cancer patients,and the prognosis of patients with lung metastasis is better.Predicting the disease progression trend according to the clinicopathological features of tumors is helpful to judge the prognosis of patients.