目的:建立新型預(yù)后評(píng)分系統(tǒng)以及探討鼠類肉瘤病毒癌基因（Kisten rat sarcoma viral oncogene,KRAS）突變?cè)谵D(zhuǎn)移性結(jié)直腸癌患者中的預(yù)后異質(zhì)性。方法:通過回顧性分析的方法,收集自2017年8月1日至2019年4月30日河北醫(yī)科大學(xué)第四醫(yī)院入住我院均經(jīng)組織病理學(xué)診斷為結(jié)直腸癌1700例患者的性別、年齡、分期、部位、脈管瘤栓及神經(jīng)受侵、淋巴結(jié)轉(zhuǎn)移、腫瘤大小、腫瘤浸潤(rùn)深度、轉(zhuǎn)移部位、KRAS突變狀態(tài)、無病生存期（Disease-free survival time,DFS）等臨床特征,建立數(shù)據(jù)庫(kù),選擇資料完整的52例KRAS突變患者,該類患者僅行KRAS檢測(cè),未行其它基因檢測(cè)。應(yīng)用SPSS21.0統(tǒng)計(jì)軟件分析數(shù)據(jù),篩選可能影響結(jié)直腸癌術(shù)后早期復(fù)發(fā)轉(zhuǎn)移的高危因素,建立預(yù)后評(píng)分系統(tǒng)。將有無脈管瘤栓或神經(jīng)受侵、分級(jí)程度、浸潤(rùn)深度、轉(zhuǎn)移部位納入簡(jiǎn)化評(píng)分系統(tǒng):僅基于臨床病理學(xué)協(xié)變量,不包括實(shí)驗(yàn)室值。從4個(gè)Cox模型獲得的風(fēng)險(xiǎn)比（Hazard ratio,HR）用于推導(dǎo)預(yù)后分值:有脈管瘤栓或神經(jīng)受侵者2.0分,分級(jí)程度為G3-G4為0.4分,侵透漿膜層者為0.3分,有肝或肺轉(zhuǎn)... 

【文章來源】：河北醫(yī)科大學(xué)河北省

【文章頁(yè)數(shù)】：51 頁(yè)

【學(xué)位級(jí)別】：碩士

【部分圖文】：

結(jié)直腸癌患者DFS的Kaplan-Meier生存曲線

12表4用于“簡(jiǎn)化分?jǐn)?shù)”的多變量模型和評(píng)分系統(tǒng)Table4Multivariatemodelsandscoringsystemsfor"simplifiedscoring"HR的95.0%置信區(qū)間HR下限上限管瘤栓或神經(jīng)受侵1.972(2.0)1.0593.671分級(jí)0.414(0.4)0.2020.85浸潤(rùn)深度0.255(0.3)0.1070.605肝或肺轉(zhuǎn)移2.370(2.4)1.1015.1012.3.1根據(jù)簡(jiǎn)化預(yù)后評(píng)分系統(tǒng)，低風(fēng)險(xiǎn)組評(píng)分范圍為（0～2.7），患者比例為55.8%，中位DFS為15個(gè)月，95%置信區(qū)間（Confidenceinterval，CI）：11.501e18.499，P<0.000；高風(fēng)險(xiǎn)組評(píng)分范圍為（2.8～5.1），患者比例為44.2％，中位DFS為9個(gè)月，95%置信區(qū)間：7.122e10.878，P<0.000，見表5及圖2。表5簡(jiǎn)易評(píng)分系統(tǒng)的正確性驗(yàn)證Table5Verificationofthecorrectnessofthesimplescoringsystem95%置信區(qū)間P低風(fēng)險(xiǎn)組11.501e18.499高風(fēng)險(xiǎn)組7.122e10.8780.000圖2結(jié)直腸癌患者低風(fēng)險(xiǎn)組與高風(fēng)險(xiǎn)組DFS的Kaplan-Meier生存曲線

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