T3、T4期结直肠癌淋巴结转移危险因素分析

目的探讨T3、T4期结直肠癌患者淋巴结转移危险因素,为临床诊疗提供参考。方法回顾性分析2008年1月至2017年12月在空军军医大学西京消化病医院行结直肠癌根治术的1112例T3、T4期结直肠癌患者的临床病理资料,分析淋巴结转移状态与临床病理因素及肿瘤标志物的相关性,应用logistic多因素回归法分析淋巴结转移的相关危险因素。结果单因素分析结果显示,性别、年龄、肿瘤部位分层的结直肠癌患者间淋巴结转移率差异均无统计学意义(均P>0.05),淋巴结转移率在不同肿瘤长径<5 cm和≥5 cm分别为37.75%(211/559)、52.26%(289/553),χ^2=23.666,P<0.01]、大体类型浸润、溃疡、蕈伞、隆起分别为37.04%(20/54)、47.52%(432/909)、34.33%(23/67)、69.51%(57/82),χ^2=13.787,P=0.003]、分化程度高、中、低分化分别为34.11%(102/299)、49.00%(317/647)、48.80%(81/166),χ^2=19.771,P<0.01]、错配修复缺陷(dMMR)是和否分别为26.34%(64/243)、50.17%(436/869),χ^2=43.996,P<0.01]、神经侵犯是和否分别为48.17%(421/874)、33.20%(79/238),χ^2=16.954,P<0.01]、脉管侵犯是和否分别为79.16%(338/427)、23.65%(162/685),χ^2=327.493,P<0.01]以及术前癌胚抗原(CEA)阳性(≥5 mg/ml)和阴性(<5 mg/ml)分别为52.87%(249/471)、39.16%(251/641),χ^2=20.162,P<0.01]和CA199阳性(≥35 U/ml)和阴性(<35 U/ml)分别为59.33%(124/209)、41.64%(376/903),χ^2=21.465,P<0.01]分层患者间差异均有统计学意义。logistic多因素回归分析显示,脉管侵犯和术前CA199阳性是T3、T4期结直肠癌患者淋巴结转移独立危险因素(OR=13.006,95%CI 9.329~17.276,P<0.01;OR=2.194,95%CI 1.513~3.181,P<0.01),dMMR阳性是淋巴结转移的保护性因素(OR=0.279,95%CI 0.190~0.411,P<0.01)。结论脉管侵犯是T3、T4期结直肠癌患者淋巴结转移的主要危险因素。术前肿瘤标志物CA199的检测可以作为预测T3、T4期结直肠癌患者淋巴结转移状态的指标,一定程度上可为诊疗方案的制订提供参考。

Risk factors of lymph node metastasis in patients with colorectal cancer in T3 and T4

Objective To investigate the risk factors of lymph node metastasis for patients with colorectal cancer in T3 and T4,and to provide a reference for clinical diagnosis and treatment.Methods The clinicopathological data of 1112 patients with colorectal cancer in T3 and T4 who underwent radical resection of colorectal cancer in Xijing Digestive Disease Hospital from January 2008 to December 2017 were retrospectively analyzed.The correlation between lymph node metastasis status and the clinicopathological factors as well as tumor markers was analyzed.The related risk factors of lymph node metastasis were analyzed by using logistic multivariate regression analysis.Results Univariate analysis showed that there was no statistically significant difference in the incidence of lymph node metastasis among colorectal cancer patients stratified by gender,age and tumor location(all P>0.05).The different tumor diameter<5 cm and≥5 cm:37.75%(211/559),52.26%(289/553),χ^2=23.666,P<0.01],general typeinfiltration,ulcer,parasol,bulge:37.04%(20/54),47.52%(432/909),34.33%(23/67),69.51%(57/82),χ^2=13.787,P=0.003],degree of differentiationhighly-differentiated,moderately-differentiated,poorly-differentiated:34.11%(102/299),49.00%(317/647),48.80%(81/166),χ^2=19.771,P<0.01],mismatch repair deficiency(dMMR)yes and no:26.34%(64/243),50.17%(436/869),χ^2=43.996,P<0.01],neurological invasionyes and no:48.17%(421/874),33.20%(79/238),χ^2=16.954,P<0.01],vascular invasionyes and no:79.16%(338/427),23.65%(162/685),χ^2=327.493,P<0.01]and preoperative carcino-embryonic antigen(CEA)positive(≥5 mg/ml)and negative(<5 mg/ml):52.87%(249/471),39.16%(251/641),χ^2=20.162,P<0.01]and CA199positive(≥35 U/ml)and negative(<35 U/ml):59.33%(124/209),41.64%(376/903),χ^2=21.465,P<0.01]had statistically significant differences in the incidence of lymph node metastasis for above stratified patients.Logistic multivariate regression analysis showed that vascular invasion and preoperative CA199-positive were independent risk factors for lymph node metastasis in patients with colorectal cancer in T3 and T4(OR=13.006,95%CI 9.329-17.276,P<0.01;OR=2.194,95%CI 1.513-3.181,P<0.01),and dMMR-positive was a protective factor for lymph node metastasis(OR=0.279,95%CI 0.190-0.411,P<0.01).Conclusions Vascular invasion is the main risk affecting factor for the lymph node metastasis of patients with colorectal cancer in T3 and T4.The detection of preoperative tumor marker CA199 can be used as an index to predict the lymph node metastasis of patients with colorectal cancer in T3 and T4.To a certain extent,it can provide a reference for the diagnosis and treatment of patients with colorectal cancer in T3 and T4.