摘要
目的探讨结直肠癌根治性切除术患者癌结节对术后肿瘤肝转移的影响。方法回顾性分析厦门大学附属东南医院2019年1月至2020年6月收治的196例结直肠癌患者的临床病理资料,所有患者均行结直肠癌根治术,根据病理结果分为癌结节组和无癌结节组,统计分析随访期间肝转移发生的例数和时间。分析患者癌结节与临床病理特征的关系,采用单因素和logistic多因素分析结直肠癌患者术后肝转移的影响因素。绘制受试者操作特征(ROC)曲线分析癌结节直径对结直肠癌术后肝转移的预测作用。结果196例结直肠癌患者中50例伴有癌结节,发生率为25.5%,癌结节直径为0.4~1.8 cm,中位直径为1.0 cm,肝转移患者46例,发生率为23.5%。癌结节组与无癌结节组患者的糖类抗原CA19-9(χ^(2)=7.55,P=0.006),肿瘤最大长径(χ^(2)=12.23,P<0.001)、T分期(χ^(2)=15.79,P<0.001)、脉管癌栓(χ^(2)=12.79,P<0.001)、淋巴结转移(χ^(2)=16.18,P<0.001)差异均有统计学意义。单因素分析发现,CA19-9(χ^(2)=7.40,P=0.007)、肿瘤最大长径(χ^(2)=8.23,P=0.004)、T分期(χ^(2)=4.58,P=0.032)、脉管癌栓(χ^(2)=12.97,P<0.001)、淋巴结转移(χ^(2)=3.96,P=0.047)、癌结节(χ^(2)=67.60,P<0.001)、癌结节直径(t=4.28,P<0.001)、癌结节数量(χ^(2)=68.77,P<0.001)均是结直肠癌患者术后肝转移的影响因素。多因素分析发现,T3-4期(OR=4.62,95%CI为1.51~7.35,P=0.003)、脉管癌栓(OR=5.42,95%CI为1.75~12.85,P<0.001)、癌结节(OR=18.54,95%CI为7.45~39.73,P<0.001)、癌结节直径(OR=13.20,95%CI为4.74~29.64,P<0.001)、癌结节数量[癌结节1枚(OR=9.11,95%CI为2.24~27.34,P<0.001)、癌结节2枚(OR=6.36,95%CI为1.38~9.08,P<0.001)、癌结节3枚(OR=5.00,95%CI为1.98~8.84,P<0.001)]均是结直肠癌患者术后肝转移的独立影响因素。ROC曲线分析发现,癌结节直径预测肝转移最佳截断值为1.1 cm[曲线下面积(AUC)=0.764,95%CI为0.632~0.896,P=0.002]。癌结节直径≥1.1 cm患者肝转移发生率为95.65%(22/23),高于癌结节直径<1.1 cm患者(40.74%,11/27),差异有统计学意义(χ^(2)=16.69,P<0.001)。结论结直肠癌患者中伴有癌结节且直径≥1.1 cm者均应警惕术后肝转移的发生。
Objective To investigate the effect of cancer nodules on postoperative liver metastasis in patients undergoing radical resection of colorectal cancer.Methods The clinicopathological data of 196 patients undergoing radical operation for colorectal cancer admitted to the Dongnan Hospital of Xiamen University from January 2019 to June 2020 were retrospectively analyzed.According to the pathological results,they were divided into cancer nodule group and non-cancer nodule group.Time and the number of liver metastasis during the follow-up period were analyzed.The relationship between cancer nodules and clinicopathological features was analyzed,and the influencing factors of postoperative liver metastasis in patients with colorectal cancer were analyzed by univariate and logistic multivaiate analysis.The receiver operator characteristic(ROC)curve was drawn to analyze the predictive effect of cancer nodule diameter on postoperative liver metastasis of colorectal cancer.Results There were 50 patients accompanied by cancer nodules in 196 patients with colorectal cancer, the incidence rate was 25.5%, the diameter of cancer nodules was 0.4-1.8 cm, the mediandiameter was 1.0 cm, and there were 46 patients with liver metastasis, the incidence rate was 23.5%. Therewere statistically significant differences in carbohydrate antigen CA19-9 (χ^(2)=7.55, P=0.006), maximumtumor diameter (χ^(2)=12.23, P<0.001), T stage (χ^(2)=15.79, P<0.001), vascular thrombus (χ^(2)=12.79, P<0.001), lymph node metastasis (χ^(2)=16.18, P<0.001) between the cancer nodule group and the non-cancernodule group. Univariate analysis showed that CA19-9 (χ^(2)=7.40, P=0.007), maximum tumor diameter (χ^(2)=8.23, P=0.004), T stage (χ^(2)=4.58, P=0.032), vascular cancer thrombus (χ^(2)=12.97, P<0.001), lymph nodemetastasis (χ^(2)=3.96, P=0.047), cancer nodules (χ^(2)=67.60, P<0.001), cancer nodule diameter (t=4.28, P<0.001), and the number of cancer nodules (χ^(2)=68.77, P<0.001) were all influential factors for postoperativeliver metastasis in colorectal cancer patients. Multivariate analysis showed that stage T3-4 (OR=4.62, 95%CI:1.51-7.35, P=0.003), vascular cancer thrombus (OR=5.42, 95%CI:1.75-12.85, P<0.001), accompanied bycancer nodules (OR=18.54, 95%CI: 7.45-39.73, P<0.001), the diameter of cancer nodules (OR=13.20,95%CI: 4.74-29.64, P<0.001), number of nodules [one cancer nodule (OR=9.11, 95%CI: 2.24-27.34, P<0.001), two cancer nodules (OR=6.36, 95%CI: 1.38-9.08, P<0.001) and three cancer nodules (OR=5.00,95%CI: 1.98-8.84, P<0.001)] were independent influencing factors for postoperative liver metastasis inpatients with colorectal cancer. ROC curve analysis showed that the best threshold of the diameter of cancernodules for predicting liver metastasis was 1.1 cm[ area under the curve( AUC)=0.764, 95%CI: 0.632-0.896,P=0.002). The incidence of liver metastasis in patients with cancer nodules diameter≥1.1 cm was 95.65%(22/23), higher than that in patients with cancer nodules diameter<1.1 cm (40.74%,11/27), with astatistically significant difference (χ^(2)=16.69, P<0.001). Conclusion Patients with colorectal cancer withcancer nodules≥1.1 cm in diameter should be vigilant against postoperative liver metastasis.
作者
王俊毅
洪楷彬
纪荣佳
陈大朝
Wang Junyi;Hong Kaibin;Ji Rongjia;Chen Dachao(Department of Oncology,909th Hospital of Joint Logistics Support Force of Chineses People's Liberation Army,Dongnan Hospital of Xiamen University,Zhangzhou 363000,China)
出处
《国际肿瘤学杂志》
CAS
2024年第5期280-285,共6页
Journal of International Oncology
关键词
结直肠肿瘤
癌结节
肝转移
外科学
病理学
Colorectal neoplasms
Cancer nodules
Liver metastasis
Surgery
Pathology
作者简介
通信作者:陈大朝,Email:19905969119@163.com。
