青年人直肠癌肝转移高危因素分析

目的 探讨青年人直肠癌肝转移的相关因素,以期降低肝转移率,延长生存时间.方法 选择青年人直肠癌患者350例,对其病理组织类型、血管侵袭、TNM分期等临床因素用Logistic回归进行单因素和多因素分析.并对有意义的指标进行相关分析,建立肝转移危险因素的回归方程.结果 120例出现肝转移,转移率为34.3%.单因素分析显示:直肠癌肝转移的相关因素主要有病理组织类型、病理大体类型、肠壁内浸润范围、血管侵袭、TNM分期、手术性质、术前血清癌胚抗原(CEA)水平、组织学分级.而性别、肿瘤部位、PCNA增殖指数、手术方式则与肝转移无关.多因素分析显示:仅血管侵袭(P=0.001)、TNM分期(P=0.001)、病理组织类型(P=0.005)、术前血清CEA水平(P=0.008)、手术性质(P=0.032)是影响肝转移的独立因素.结论 青年人直肠癌患者病理组织类型为高度恶性潜能、术前血清CEA水平高表达、进展期、有血管侵袭者和手术性质为非R0者,易发生肝转移,术后应予严密随访、个体化辅助治疗.

Factors analysis on liver metastasis from rectal cancer

Objective To detect the clinical factors related with liver metastasis in young patients with rectal cancer.Methods Three hundred and fifty young patients with rectal cancer were collected to set up the database.Single and multi-factor Logistic regression was applied to indicate the independent factors relating to liver metastasis.The regression equation to predict probability of liver metastasis from rectal cancer was established.Results Liver metastasis was 120 cases (34.3%).Single-factor analysis revealed that patho-organization type,pathologytype,infiltration extent,blood vessel invasion (BVI),TNM stage,operation character,the preoperative level of carcino-embryonic antigen,histology grading were related with liver metastasis.Multi-factor analysis revealed that only BVI (P=0.001),TNM stage (P=0.001),pathoorganization type (P=0.005),the preoperative level of CEA (P=0.008) and operation character (P=0.032) were independent factors to predict probability of liver metastasis.Conclusions Rectal cancer of young patients who being with BVI,advanced phase,high preoperative level of CEA,radical operation or poor differentiation degree,are apt to develop liver metastasis.They should be given further individualized intensive adjuvant treatment.