结直肠癌根治术后单纯性肺转移60例临床病例分析

目的:结直肠癌患者根治术后大约有50%会发生远处转移,最常见的转移部位是肝,其次是肺,本文旨在探讨结直肠癌根治术后肺转移的特点、治疗效果和影响预后的因素.方法:随访1967年至2002年间的结直肠癌根治术后发生单纯性肺转移的60例病例,对其临床资料进行回顾性分析和总结.结果:自原发灶切除术后全组病例中位生存时间 37 个月,其中有15例行转移灶的切除手术,中位生存 51个月;其余 45例行非手术治疗,中位生存34 个月;转移瘤大于3个组生中位生存时间 30月,转移瘤小于等于3个组中位生存时间43个月.患者的总生存率可能和是否手术、转移灶的个数有关,而年龄、性别、原发灶病理类型、分期、转移灶大小对生存率无明显影响.结论:结直肠癌根治术后单纯性肺转移的积极治疗是有效的,手术及转移灶个数可能是影响治疗效果的因素.     

结直肠癌肺转移患者手术切除肺转移灶的疗效及预后分析

目的 探讨结直肠癌肺转移患者手术切除肺转移灶的疗效及影响术后生存的因素。方法回顾性分析35例结直肠癌肺转移行肺转移灶切除患者的临床资料。结果全组患者中位随访时间48．0个月。中位生存时间为36．0个月,5年生存率为33．0％。19例患者死于肿瘤进展：16例生存患者中,10例带瘤生存．6例无瘤生存。其中1例至今已无瘤生存164个月。单因素分析结果显示,无瘤间期（DFI）时间的长短对肺转移瘤切除术后的生存有影响（P=0．036）：而患者的性别、年龄、原发肿瘤部位、肺转移瘤大小和位置、手术方式、肺转移瘤手术前CEA水平及复发后再次行肺转移瘤切除均未见与其术后生存时间有关。结论对于部分选择性结直肠癌肺转移患者．手术是有潜在治愈可能的治疗方式。DFI可能与肺转移瘤切除术后生存相关。     

结直肠癌肝转移合并同时性肺转移患者手术治疗疗效分析

背景与目的：对于结直肠癌肝转移合并可切除肺转移的患者,手术治疗的疗效已经得到广泛认可,但对于合并不可切除的肺转移患者的治疗策略仍需要进一步明确。因此,本研究通过对笔者单位收治的结直肠癌肝转移合并同时性肺转移患者临床资料的回顾性分析,以期为该类患者的治疗提供数据参考。方法：本研究采用回顾性队列研究方法,纳入2008年1月—2020年12月期间在北京大学肿瘤医院肝胆胰外一科行手术治疗的127例结直肠癌肝转移合并同时性肺转移患者的资料,所有患者原发灶及肝转移灶均按肿瘤根治原则行完整切除（R0/R1）,其中31例行肺转移灶的根治性局部治疗（局部治疗组）,96例肺转移灶未行局部治疗（非局部治疗组）,比较两组患者的临床资料、总生存时间（OS）、无复发生存时间（RFS）,并对非局部治疗组的患者进行预后相关因素分析。结果：除局部治疗组肺转移灶直径大于非局部治疗组外（P<0.05）,两组其余一般临床资料均无明显差异（均P>0.05）。全组患者中位随访时间为30 (5～134)个月,失访率3%。全组患者中位OS为41 (4～118)个月,1、3年OS率分别为96.8%和59.7%,其中非局部治...     

金属支架和腹腔镜在结直肠癌伴梗阻治疗中的应用价值

目的研究联合金属支架与腹腔镜手术在治疗结直肠癌伴梗阻治疗中的疗效。方法将2012年3月至2015年3月期间收治的48例高龄结直肠癌伴梗阻病人分为两组,①观察组:24例结直肠癌伴梗阻病人,植入金属支架缓解梗阻作为过渡治疗,完善相关术前准备,之后在腹腔镜下行结直肠癌根治性切除术;②对照组:24例结直肠癌伴梗阻的同期病人直接采取腹腔镜下结直肠癌切除术。结果①采取过渡性植入金属支架后进行根治性手术的病人24例,其中21例施行根治性切除,2例因转移至肝脏和肺未能切除,另1例因房颤未行金属支架置入术和腹腔镜结直肠癌切除术。术后随访24例,随访时间12~29个月,平均21个月。其中施行根治性切21例均无复发和转移,3例未能切除者死于肿瘤远处转移。对照组:24例采取直接腹腔镜手术治疗,24例行根治性手术,2例因术后肠瘘、多器官功能衰竭死亡,1例因术后发生胃转移死亡。随访:24例,随访时间10~24个月,平均15个月,对比两组病人,发现病人在支架置入后行腹腔镜根治术,术后并发症及生活质量有显著改善,生存时间并无明显差异。结论相比直接采取腹腔镜手术切除的病人,联合金属支架植入与腹腔镜手术治疗方式具有安全、术后并发症少等优点,可提高病人生存质量,两组病人在生存时间上无明显差异。     

结直肠癌肝转移综合治疗预后因素分析（附317例报告）

目的 探讨影响结直肠癌肝转移以外科手术为主的综合治疗疗效的预后风险因素。方法 回顾性分析北京大学肿瘤医院肝胆胰外一科2005年1月至2015年1月行肝切除手术治疗317例结直肠癌肝转移病人的临床资料及术后随访情况。结果 全组病人1、3、5年总存活率分别为90.5%、54.5%、45.0%。中位生存期43个月。单因素分析结果显示性别、原发灶淋巴结转移、肝转移灶最大径、肝转移灶出现时间、癌胚抗原（CEA）水平及是否存在肝外转移灶是影响预后的因素（P<0.05）;多因素分析结果显示原发灶淋巴结转移、同时性肝转移和CEA>30 μg/L是影响预后的独立危险因素。结论 以外科手术为主的综合治疗可显著改善结直肠癌肝转移病人的长期生存,多种临床风险因素影响病人预后。     

结直肠癌肝转移根治性切除预后因素分析

目的 分析影响结直肠癌肝转移患者根治性手术切除预后的临床病理因素,探讨改善患者预后的方法.方法 收集2005年1月至201 1年12月江苏省苏北人民医院和复旦大学附属肿瘤医院收治的103例结直肠癌肝转移根治性切除患者的临床资料.采用Kaplan-Meier法计算生存率,用Log-rank法分析患者生存情况,对各种影响预后的因素分别进行单变量和多变量Cox回归分析.结果 103例患者均获随访,随访时间10～ 60个月,术后1、3、5年生存率分别为90％、49％、39％.单因素分析结果显示:肝转移灶数目、大小、分布、术前CEA水平、手术并发症、术后化疗是肝转移灶切除术后的影响因素(x2值分别为24.732、9.461、9.568、25.948、25.370、5.701,P＜0.05);多因素分析显示,肝转移灶数目、肝转移灶切除术前CEA水平、手术并发症是影响预后的独立因素(Wald=7.974、12.051、11.547,P＜0.05).结论 肝转移灶数目、肝转移灶切除术前CEA水平和手术并发症是影响结直肠癌肝转移患者预后的独立因素.适当扩大手术切除的适应证,加强对高危患者的随访和术后辅助化疗,可能改善肝转移患者的预后.     

结直肠癌肝转移复发再次肝切除术的疗效与预后分析

目的 探讨再次肝切除术在结直肠癌肝转移复发治疗中的应用价值.方法 回顾性分析43例结直肠癌肝转移复发再次肝切除术和67例结直肠癌肝转移复发内科化疗的临床资料.结果 结直肠癌肝转移复发再手术组和化疗组1,3,5年生存率分别为83.7％,51.1％,27.9％和65.7％,20.6％,3.0％(P＜0.05或P＜0.01).再次肝切除组无手术死亡病例,并发症发生率为32.6％.单因素分析显示肝脏复发转移灶个数,切缘情况,CEA,肿瘤大小,肿瘤分化程度与预后有关.多因素回归分析结果表明,仅有肝脏复发转移灶个数和肿瘤大小为影响预后的独立因素.结论 再次肝切除术对于结直肠癌肝转移复发是安全的治疗方案,肿瘤负荷较小(癌直径＜5 cm和转移灶＜3个)的患者预后较好;再次手术可以延长结直肠癌肝转移复发患者的生存时间.     

结直肠癌肝转移危险及预后因素分析

肝脏是结直肠癌最常见的远处转移器官,结直肠癌病人出现肝转移一般预后较差。结直肠癌肝转移分为同时性肝转移和异时性肝转移,对众多的临床以及病理学特征进行的单因素和多因素回归分析提示,影响结直肠癌发生肝转移的危险因素有：浸润深度、淋巴结转移、癌结节、分化程度、癌胚抗原和糖类抗原等。影响结直肠癌肝转移病人预后的因素有：肝转移灶大小及数目、肝外器官转移、原发灶手术切除、肝转移灶手术切除、全身药物治疗等。因此,手术切除肝转移灶、药物治疗获得手术切除机会等治疗模式能够最大程度地提高结直肠癌肝转移病人的存活率。由众多因素组合起来的评分系统,能够较好地预测结直肠癌肝转移病人的预后。     

胰头癌根治性胰十二指肠切除术后肿瘤早期复发的影响因素分析

目的探讨胰头癌根治性胰十二指肠切除术后肿瘤早期复发的影响因素。方法采用回顾性病例对照研究方法。收集2014年5月至2015年5月复旦大学附属肿瘤医院收治104例胰头癌行根治性切除术病人的临床病理资料;男62例,女42例;年龄为(61±10)岁。病人均行根治性胰十二指肠切除术。观察指标:(1)手术情况。(2)随访情况。(3)影响胰头癌根治性胰十二指肠切除术后肿瘤早期复发的因素。采用电话方式进行随访,了解病人复发情况。随访时间截至术后1年。正态分布的计量资料以x±s表示。计数资料以绝对数表示,组间比较采用χ²检验。多因素分析采用Logistic回归模型。结果(1)手术情况:104例病人均顺利完成根治性胰十二指肠切除术,术中出血量为(474±280)mL,淋巴结清扫数目为(21±10)枚。(2)随访情况:104例病人术后均获得随访,其中44例肿瘤早期复发。44例肿瘤早期复发病人中,腹腔内复发42例(肝转移23例、术区转移7例、后腹膜淋巴结转移7例、网膜转移5例);腹腔外复发2例(胸膜、肺转移各1例)。(3)影响胰头癌根治性胰十二指肠切除术后肿瘤早期复发的因素:单因素分析结果显示术前CA19-9水平、术后CA19-9水平、淋巴结转移数目是影响胰头癌根治性胰十二指肠切除术后肿瘤早期复发的相关因素(χ²=5.833,9.276,4.261,P<0.05)。多因素分析结果显示:术后CA19-9水平>37 U/mL是影响胰头癌根治性胰十二指肠切除术后肿瘤早期复发的独立危险因素(优势比=3.599,95%可信区间为1.551~8.347,P<0.05)。结论术后CA19-9水平>37 U/mL是影响胰头癌根治性胰十二指肠切除术后肿瘤早期复发的独立危险因素。     

结直肠癌肝转移不同治疗方式的预后比较

目的探讨不同治疗方式对结直肠癌肝转移生存时间和无复发生存时间的影响。方法回顾性分析2002年1月至2013年5月期间解放军总医院收治的71例结直肠癌肝转移患者的临床资料,分析干预对结直肠癌肝转移患者生存时间和无复发生存时间的影响。结果 71例结直肠癌肝转移患者的原发灶均行根治性切除。对肝转移灶,20例未予干预(未干预组);20例行肝转移灶切除,20例行射频消融,11例行肝转移灶切除+射频消融(所有接受干预的患者为干预组)。Cox比例风险模型结果显示,在控制其他因素的情况下,干预对生存(HR=1.724,P=0.043)和无复发生存(HR=0.701,P=0.048)均有影响,接受干预患者的生存情况和无复发生存情况较好。结论在对结直肠癌行根治性手术的条件下,对结直肠癌肝转移灶给予干预措施可以延长结直肠癌肝转移患者的生存时间和无复发生存时间。     

Pulmonary Resection for Colorectal Cancer Metastases: Duration Between Cancer Onset and Lung Metastasis as an Important Prognostic Factor

Background  Pulmonary resection is the most effective treatment available for colorectal lung metastases. However, the characteristics of those patients most likely to benefit from surgical resection have not yet been adequately clarified. We have made a critical analysis for the potential prognostic factors and their clinical significance in lung metastasis from colorectal cancer. Methods  We analyzed 63 consecutive patients who underwent curative pulmonary resection for colorectal lung metastases at National Taiwan University Hospital from January 1997 to December 2006. Median follow-up was 37.3 (range 12–122) months. Disease-free and overall survival rates were evaluated by Kaplan–Meier analysis, and multivariate analyses of various prognostic characteristics were performed. Results  Overall 5-year survival and disease-free survival rates were 43.9% and 19.5%, respectively. Multivariate analysis showed that the interval for development of lung metastases from primary colorectal cancer and the mode of operation were the only two independent prognostic factors for survival. With regard to disease-free survival, the interval between initial resection of colorectal cancer and following lung metastases was the only significant independent prognostic factor. Besides, subset analysis showed that the 5-year survival rate in repeated resection group for recurrence of colorectal metastasis in residual lung was 85.7%. Conclusion  Pulmonary resection, initial or even repeated resection for metastatic tumor from colorectal cancer should be encouraged for selected patients as it can significantly improve survival. Patients who have lung metastases within 1 year after primary tumor resection and those who do not undergo anatomical resection for metastatic lung tumor should be followed more carefully due to poor prognosis.     

Sequential resection of lung metastasis following partial hepatectomy for colorectal cancer

BACKGROUND: Multiple organ metastases from colorectal carcinoma may be considered incurable, but long survival after both liver and lung resection for metastases has been reported. METHODS: A retrospective analysis of 48 patients who underwent lung resection for metastatic colorectal cancer between 1992 and 1999 was undertaken. Twenty-seven patients had lung metastasis alone, 15 had previous partial hepatectomy, and six had previous resection of local or lymph node recurrence. The relationship of clinical variables to survival was assessed. Survival was calculated from the time of first pulmonary resection. RESULTS: Five-year survival rates after resection of lung metastasis were 73 per cent in patients without preceding recurrence, 50 per cent following previous partial hepatectomy and zero after resection of previous local recurrence. Independent prognostic variables that significantly affected survival after thoracotomy were primary tumour histology and type of preceding recurrence. There was no significant difference in survival after lung resection between patients who had sequential liver and lung resection versus those who had lung resection alone. CONCLUSION: Sequential lung resection after partial hepatectomy for metastatic colorectal cancer may lead to long-term survival.     

Pulmonary resection for metastases from colorectal cancer: factors influencing prognosis. Twenty-year experience.

OBJECTIVE: We reviewed our experience in the surgical management of 80 patients with colorectal pulmonary metastases and investigated factors affecting survival. MATERIAL AND METHODS: From January 1980 to December 2000, 80 patients, 43 women and 37 men with median age 63 years (range 38-79 years) underwent 98 open surgical procedure (96 muscle-sparing thoracotomy, one clamshell and one median sternotomy) for pulmonary metastases from colorectal cancer (three pneumonectomy, 17 lobectomy, seven lobectomy plus wedge resection, six segmentectomy, three segmentectomy plus wedge resection and 62 wedge resection). Pulmonary metastases were identified at a median interval of 37.5 months (range 0-167) from primary colorectal resection. Second and third resections for recurrent metastases were done in seven and in four patients, respectively. RESULTS: Operative mortality rate was 2%. Overall, 5-year survival was 41.1%. Five-year survival was 43.6% for patients submitted to single metastasectomy and 34% for those submitted to multiple ones. Five-year survival was 55% for patients with disease-free interval (DFI) of 36 months or more, 38% for those with DFI of 0-11 months and 22.6% for those with DFI of 12-35 months (P=0.04). Five-year survival was 58.2% for patients with normal preoperative carcino-embryonic antigen (CEA) levels and 0% for those with pathologic ones (P=0.0001). Patients submitted to second-stage operation for recurrent local disease had 5-year survival rate of 50 vs. 41.1% of those submitted to single resection (P=0.326). CONCLUSIONS: Pulmonary resection for metastases from colorectal cancer may help survival in selected patients. Single metastasis, DFI>36 months, normal preoperative CEA levels are important prognostic factors. When feasible, re-operation is a safe procedure with satisfactory long-term results.     

直肠癌根治性前切除后复发转移的危险因素

目的 研究直肠癌根治性前切除后复发转移的危险因素。方法 回顾性分析1983—2000年间单个医疗机构直肠癌根治性前切除的957例患者的临床资料，分析复发转移的危险因素。结果 共计有150例患者（15．7％）复发转移，复发转移部位依次为盆腔内局部复发57例（6．0％）、肝脏转移47例（4．9％）、肺部转移40例（4．2％）和其他部位转移6例（0．6％），中位复发转移时间18个月（2—85个月）。复发转移后中位生存8个月（1—62个月）。23例患者（15．3％）切除了肿瘤，术后中位生存30个月，生存超过5年者只有3例（13．0％）。低龄（P=0．024）、有肿瘤家族史（P=0．000）、癌胚抗原（CEA）水平（P=0．003）、肿瘤浸透肌层（P=0．000）、淋巴结转移（P=0．000）、脉管瘤栓（P=0．000）、印戒细胞癌或黏液腺癌（P=0．000）显著增加复发转移的风险。Logistic回归分析发现，肿瘤家族史（P=0．001）、CEA阻性（P=0．033）、肿瘤浸透肌层（P=0．000）、淋巴结转移（P=0．000）、脉管瘤栓（P=0．001）、印戒细胞癌或者黏液腺癌（P=0．012）是有显著统计学意义的复发转移的危险因素。结论 直肠癌根治性前切除后存在特定的复发转移危险因素。盆腔、肝脏和肺是肿瘤复发转移的主要部位。     

Prognostic factors in resection of pulmonary metastasis from colorectal cancer

BACKGROUND: The aim of this retrospective study was to evaluate characteristics of primary colorectal cancer and pulmonary metastases in order to identify prognostic factors for overall survival and risk factors for further intrapulmonary recurrence after resection of pulmonary metastases from colorectal cancer. METHODS: Forty-nine patients who underwent resection of pulmonary metastases from colorectal cancer were reviewed. The factors assessed were age, sex, pathological findings of the original colorectal cancer (depth, lymphatic invasion, venous invasion, lymph node metastasis, differentiation, Dukes' stage) and pulmonary metastasis (maximum tumour size, number of tumours, completeness of resection), serum carcinoembryonic antigen level, previous hepatectomy for liver metastases, and surgical procedure for resection of pulmonary metastasis. Overall survival and intrapulmonary recurrence were also reviewed. RESULTS: Survival rates after resection of pulmonary metastases were 78 per cent at 3 years and 56 per cent at 5 years. Solitary pulmonary metastases were significantly correlated with survival (P = 0.049). The pathological features of the primary colorectal cancer had no impact on survival. Histologically incomplete resection of pulmonary metastasis significantly correlated with pulmonary re-recurrence (P = 0.034). CONCLUSION: Long-term survival can be expected after complete resection of pulmonary metastases arising from colorectal cancer, especially in patients with a solitary pulmonary metastasis.     

大肠癌脑转移的临床特征及其手术治疗

目的 分析大肠癌脑转移的临床特征及其手术治疗转归. 方法回顾性分析手术治疗的大肠癌伴脑转移28例患者的临床资料,统计数据采用单因素Log-Rank分析和多因素Cox回归分析法.结果 大肠癌继发脑转移的中位年龄为57(41～75)岁,原发肿瘤与转移瘤间隔的中位时间为13.5个月,其中合并颅外(肺、肝、骨)转移占61%(17/28),仅有脑转移的占39%(11/28).脑转移瘤主要表现为头痛、呕吐等颅内压升高征候群和偏瘫、下肢乏力、失语等定位症状以及癫痫等,颅内转移瘤以单发病灶为多见,占82%(23/28),位于幕上(枕叶、顶叶、额叶)者占57%(16/28),位于幕下(小脑)者占43%(12/28);转移性脑瘤手术切除后中位生存时间为9.4个月,1年生存率为28.9%,5年生存率为7.1%.多因素分析提示颅内单发病灶转移(χ2=7.35,P<0.05)和无颅外其他部位转移(χ2=6.47,P<0.05)是大肠癌脑转移预后的独立影响因素.28例均接受手术切除和多学科协作治疗,无手术死亡和出血及再手术病例.结论 大肠癌脑转移总体预后欠佳,手术切除脑转移病灶可延长部分患者的存活时间.     

影响结直肠癌肝转移手术切除患者预后的多因素分析

目的 探讨影响结直肠癌肝转移患者手术切除的预后因素。方法 收集1995-2001年间收治的结直肠癌肝转移手术切除患者103例的资料，用Kaplan-Meier法计算术后生存率，以Cox模型进行多变量分析。结果 患者术后1、3年无瘤生存率分别为73．8％和43．7％，术后1、3年累积生存率分别为7g．6％和49．5％。单因素分析显示：术前血清CEA水平、转移灶与原发灶的治疗间隔时间、术中切缘情况、肝门淋巴结转移、肝内卫星灶的存在与否、肝转移灶的最大直径、数目及有无包膜影响患者的术后肝内复发和术后累积生存率，而术后化疗可以提高患者的累积生存率。多因素分析显示：转移灶与原发灶的治疗间隔时间、切缘情况、肝内卫星灶的存在与否和肝转移灶的最大直径是影响肝内复发和累积生存率的独立因素，而肝门淋巴结转移是影响累积生存率的独立因素，有无包膜是影响肝内复发的独立因素。结论 手术切除是结直肠癌肝转移有效的治疗手段。转移灶与原发灶的治疗间隔时间、切缘情况、肝内卫星灶、肝转移灶的大小和包膜、肝门淋巴结转移等是患者预后的独立影响因素。     

Surgical resection of pulmonary metastases from colorectal adenocarcinoma. Special reference to repeated pulmonary resections

Pulmonary resection of metastatic lesions from colorectal adenocarcinoma was performed in 35 patients. The cumulative 5-year survival was 38%. The primary site of cancer was the colon in about half of the patients. Patients with a solitary metastasis or tumors smaller than 3 cm in diameter survived longer than did patients with multiple metastases or tumors larger than 3 cm but the differences were not significant. Other factors, including age, sex, histologic grade of tumor, location and stage of primary carcinoma, location of pulmonary metastases, disease-free interval, and type of pulmonary resection, had no apparent influence on survival time. The lung was the major site of recurrence following pulmonary resection. Seven patients underwent two or more pulmonary resections for metastasis from a colorectal carcinoma. At the time of last follow-up, four patients were alive and free of recurrent disease at 5, 34, 39, and 58 months after the second pulmonary resection. These data suggest that some patients will survive for a long time following pulmonary resection of colorectal metastases, and for highly selected patients, repeated pulmonary resection may further extend survival.     

Pre- and postoperative carcinoembryonic antigen determinations in hepatic resection for colorectal metastases. Predictive value and implications for adjuvant treatment based on multivariate analysis.

OBJECTIVE: The object of this study was to evaluate the prognostic significance of pre- and postoperative serum carcinoembryonic antigen (CEA) levels in the resectional treatment of colorectal hepatic metastases. The main question was whether postoperative CEA levels correlated with survival and the time to recurrence. SUMMARY BACKGROUND DATA: Despite numerous investigations on prognostic factors in colorectal cancer, only sparse data are available to estimate the patient's individual risk for tumor recurrence postoperatively. It is controversial whether preoperative CEA values are of prognostic significance, and after observing the kinetics of CEA decline, elevated CEA levels postoperatively were found to be an ominous sign. CEA therefore could indicate the presence of a tumor burden after resection. METHODS: One hundred sixty-six patients undergoing hepatic resection for colorectal metastases with curative intent were prospectively documented and underwent multivariate analysis for indicators of prognosis. RESULTS: Abnormal preoperative CEA levels were not of prognostic significance compared with values within the normal range (survival, 36 vs. 30 months; p = 0.12; disease-free survival, 12 vs. 10 months; p = 0.82). The postoperative serum CEA level, however, was the most predictive factor with regard to survival and the disease-free interval. Patients in whom CEA levels were abnormal before surgery and returned into the normal range after resection had significantly better survival times (37 vs. 23 months, p = 0.0001) and disease-free survival times (12 vs. 6.2 months, p = 0.0001) compared with patients with persistently abnormal values. CONCLUSIONS: Pre- and postoperative determination of the serum CEA level is mandatory to judge whether a curative resection has been performed and whether tumor has been left behind after the operation. Postoperative CEA levels also should be used as a stratification criterion in adjuvant treatment studies after hepatic resection to indicate patients with a high risk of tumor recurrence.     

T1期结直肠癌淋巴结转移的危险因素分析及其列线图预测模型的应用价值

目的探讨T1期结直肠癌淋巴结转移的危险因素及其列线图预测模型的应用价值。方法采用回顾性病例对照研究方法。收集2008年6月至2019年12月复旦大学附属中山医院收治的914例行根治性切除术T1期结直肠癌病人的临床病理资料;男528例,女386例;中位年龄为63岁,年龄范围为25~87岁。观察指标:(1)T1期结直肠癌病人的临床病理资料。(2)随访情况。(3)淋巴结转移的影响因素分析。(4)列线图预测模型的建立及内部验证。病人术后定期随访,术后2年内每3个月随访1次,随后每6个月随访1次,术后随访5年,了解病人的肿瘤复发和生存情况。正态分布的计量资料以x±s表示,组间比较采用t检验;偏态分布的计量资料以M(范围)表示。计数资料以绝对数或百分比表示,组间比较采用χ2检验。采用Kaplan-Meier法计算生存率和绘制生存曲线。采用Log-rank检验进行生存分析。单因素和多因素分析均采用Logistic回归分析。根据多因素分析结果,应用R语言软件建立基于Logistic回归的淋巴结转移概率预测列线图。采用校准度曲线评价模型预测结局发生概率与实际观测概率一致程度,以一致性指数(C-index)表示。采用Bootstrap方法评价模型性能,得出校准度曲线。采用Hosmer-Lemeshow检验计算模型的拟合优度。结果 (1)T1期结直肠癌病人的临床病理资料:914例病人中,直接手术687例,内镜切除后补救手术227例;术后组织病理学检查证实均为pT1NxM0期结直肠癌;肿瘤长径为(2.3±1.2)cm;肿瘤病理学类型腺癌为865例,黏液性腺癌为49例;肿瘤分化程度为高中分化727例,低未分化187例;黏膜下浸润深度≥1 000 μm 633例,<1 000 μm 281例;神经脉管侵犯110例,未受侵犯804例;术中淋巴结清扫数目为13枚(1~48枚);N分期为N0期804例,N1期98例,N2期12例。无围术期死亡病人。(2)随访情况:914例病人中,886例获得术后随访,随访时间为25个月(1~129个月);随访期间肿瘤复发或转移24例。914例病人5年肿瘤累积复发率为4.8%,中位复发时间为17.0个月,肝脏为最常见的肿瘤复发部位,占比为58.3%(14/24)。914例病人5年无复发生存率为95.2%。804例无淋巴结转移病人5年无复发生存率为96.3%,110例有淋巴结转移病人为86.6%,两者比较,差异有统计学意义(χ2=6.83,P<0.05)。(3)淋巴结转移的影响因素分析:单因素分析结果为术前癌胚抗原(CEA)、术前CA19-9、肿瘤分化程度、黏膜下浸润深度、神经脉管侵犯是影响T1期结直肠癌淋巴结转移的相关因素(优势比=2.56、3.25、2.21、2.68、3.39,95%可信区间为1.41~4.67、1.22~8.66、1.43~3.41、1.56~4.88、2.10~5.48,P<0.05)。多因素分析结果显示:术前CEA≥5 μg/L、术前CA19-9≥37 U/mL、肿瘤分化程度为低未分化、黏膜下浸润深度≥1 000 μm、神经脉管侵犯是影响T1期结直肠癌淋巴结转移的独立危险因素(优势比=2.23、3.47、2.01、2.31、2.91,95%可信区间为1.02~4.15、1.08~10.87、1.03~3.27、1.40~4.47、1.64~5.13,P<0.05)。(4)列线图预测模型的建立及内部验证:根据多因素Logistic分析结果,构建预测T1期结直肠癌淋巴结转移列线图模型。术前CEA≥5 μg/L、术前CA19-9≥37 U/mL、肿瘤分化程度为低未分化、黏膜下浸润深度≥1 000 μm、神经脉管侵犯得分分别为59、100、48、67、92分。根据每项临床病理因素评分,加和得总分后评估淋巴结转移概率。绘制受试者工作特征曲线评价列线图模型的淋巴结转移预测能力,其结果显示:列线图预测模型曲线下面积为0.70(95%可信区间为0.64~0.75,P<0.05)。Bootstrap法验证列线图预测模型的预测效能,C-index值为0.70(95%可信区间为0.65~0.75)。校准度曲线显示该列线图模型的预测概率和实际淋巴结转移概率具备较好的一致性。Hosmer-Lemeshow检验计算模型的拟合效果好(χ2=1.61,P>0.05)。结论术前CEA≥5 μg/L、术前CA19-9≥37 U/mL、肿瘤分化程度为低未分化、黏膜下浸润深度≥1 000 μm、神经脉管侵犯是影响T1期结直肠癌淋巴结转移的独立危险因素;以此构建列线图预测模型,可以预测T1期结直肠癌淋巴结转移概率。