Survival Analysis Of Colon And Rectal Cancer And Clinical Significance Of Ki-67 In Colorectal Cancer

Part One Survival Analysis of Colon and Rectal CancerObjective:Colorectal cancer is one of the most common gastrointestinal malignancies in the world,and its incidence is third in malignant tumors.Although the prognosis of patients with colorectal cancer has been greatly improved with the operation-based comprehensive treatment,the five-year survival rate after surgery can only reach 60-70%.With the development of science,especially the emergence of molecular biomarkers,it is an urgent task to establish a prognostic assessment system based on individual characteristics and molecular biomarkers.This article focuses on the differences between the epidemiological features,clinical manifestations,pathological types and survival prognosis of colon and rectal cancer,and further study was finished on the effect of KRAS gene status,hepatic metastasis type,and liver metastasis treatment methods on the survival of patients with colorectal cancer.Method:We collected the data of patients with colon cancer or rectal cancer who were hospitalized in the Department of Oncology at the Fourth Hospital of Hebei Medical University from January 2010 to December 2014.The study starts with operation time the date of clinical biopsy pathology,to patients died,lost or the latest follow-up time for the node.The end of the study is death.We finished the patients’follow-up data and use SPSS 18.0statistical software for data analysis.P<0.05 was statistically significant.The overall survival was used as the observation index.Kaplan-Meier method was used to plot the survival curve.The Cox regression model was used for multivariate analysis.Consequence:1.In the study of colon cancer and rectal cancer,a total of 604 patients had complete follow-up data,the median follow-up time was 23 months(1 to60 months),and there was no significant difference in OS between colon cancer and rectal cancer(P=0.73).2.Factors that were statistically significant by univariate analysis were age,pathological stage,initial treatment,and preoperative or postoperative intestinal obstruction(P=0.010,P=0.005,P=0.000,P=0.000).Further COX regression multivariate analysis showed that preoperative intestinal obstruction,pathological stage and initial treatment were risk factors for survival(P=0.021,P=0.004,P=0.000).3.Among the 604 follow-up patients,84 patients underwent K-RAS gene detection.The median survival time of K-RAS wild type patients was 32.3months,and the median survival time of K-RAS mutation patients was 26.2months.The difference was statistically significant(P=0.005);in patients with K-RAS mutations,the median survival time was 24.0 months for patients with12-codon mutations,and 20.6 months for patients with 13-codon mutations,12There was no significant difference in the survival difference between codon mutation patients and 13 codon mutation patients(P=0.861).4.There were 387 patients with liver metastases in 604 patients with colorectal cancer,and the median OS of patients with simultaneous liver metastases was 20.2 months,and the median OS was 25.9 months in patients with heterotopic liver metastases.OS was superior to patients with heterotopic liver metastases(P=0.000).According to the liver metastases treatment method:log-rank results showed that the median survival time was 28.5 months in the local intervention and systemic chemotherapy group,and the median survival time was 19.7 months in the systemic chemotherapy alone group,the local intervention and systemic chemotherapy group prognosis Better than pure chemotherapy group(P=0.000).Part Two Clinical Significance of Ki-67 in Colorectal CancerObjective:The Ki-67 antigen is a cell proliferation-related protein that has so far become a commonly used indicator in clinical pathology to estimate tumor growth scores,such as breast and neuroendocrine cancers.With regard to the prognostic role of Ki-67 in colorectal cancer,only a few studies exist and some show conflicting results.To this end,we further explore the correlation between the expression of Ki-67 and clinicopathological features of colorectal cancer,and use statistical methods to analyze and guide the clinical app-lication.Method:To collect data on the incidence of Ki-67 positive colorectal cancer patients hospitalized in the Department of Oncology of the Fourth Hospital of Hebei Medical University from January 2010 to December 2014,and to sort out follow-up data of the patients according to colorectal cancer tumor resection.The study starts with operation time the date of clinical biopsy pathology,to patients died,lost or the latest follow-up time for the node.The end of the study is death.The percentage of expression of Ki-67 in pathological or colonos-copic findings was taken as the median,and then the clinicopa-thological parameters of patients with different expression of Ki-67and the proportion of sex,tumor site,and number of lymph nodes were used as SPSS 21.0.The statistical analysis of the software finally yielded correlationsbetweendifferentKi-67expressionandvarious clinicopathological parameters.Consequence:1.At the end of follow-up,a total of 102 patients with colorectal cancer positively expressed in Ki-67 were followed-up.The median Ki-67 was 70%.The expression of Ki-67 had no significant effect on the survival time of colorectal cancer(P=0.50)..2.Took Ki-67 median 70%as the point of demarcation,usingχ~2test analysis,the results showed that Ki-67 expression and pathological staging there is a correlation(P=0.045),and tumor location,gender,age,There was no significant correlation between the positive rate of lymph nodes and preoperative or postoperative intestinal obstruction(P=0.134,P=0.292,P=0.276,P=0.642,P=0.317).Conclusion:1.There was no significant difference in the median OS between colon cancer and rectal cancer.Preoperative intestinal obstruction,pathological staging,and initial treatment were independent predictors of survival.2.There was a difference in survival between patients with K-RAS wild-type and those with K-RAS mutation in colorectal cancer,and K-RAS wild-type patients had better survival than patients with K-RAS mutation.In patients with K-RAS mutation in colorectal cancer,there was no significant difference in the survival of patients with mutations of 12 codons and 13codons.3.For patients with colorectal liver metastases,patients with heterotopic liver metastases survive better than those who have simultaneous liver metastases.In the treatment of patients with colorectal liver metastases,patients who received topical and systemic chemotherapy survive better than those who received systemic chemotherapy alone.4.There was no significant correlation between the expression of Ki-67and the survival of patients with colorectal cancer.5.The expression of Ki-67 was correlated with the pathological stage of colorectal cancer patients,but there was no significant correlation between the expression of Ki-67 and the location,gender,age,lymph node number and preoperative intestinal obstruction.