结直肠癌患者脉管侵犯的危险因素及预后分析

目的探讨结直肠癌患者脉管侵犯的危险因素及其对预后的影响。 方法回顾性分析2010年1月至2013年12月济南市槐荫人民医院胃肠外科收治并行根治性手术治疗的319例结直肠癌患者的临床病理资料，收集患者术后肿瘤标本，采用免疫组织化学染色检测肿瘤标本的脉管侵犯情况，采用χ²检验或Fisher确切概率法分析脉管侵犯与临床病理资料之间的关系，采用Kaplan-Meier法分析脉管侵犯对结直肠癌患者生存预后(随访截至2018年12月)的影响，采用Logistic多因素回归模型分析脉管侵犯的独立危险因素。 结果319例患者，脉管侵犯率为28.84%(92/319)，低分化者脉管侵犯率为37.08%(33/89)，高于高-中分化者25.65%(59/230)，差异有统计学意义(χ²＝4.08，P＝0.043)；T3和T4分期患者脉管侵犯率分别为31.33%(26/83)和34.09%(60/176)，高于T1和T2期患者的11.11%(1/9)和9.80%(5/51)(χ²＝12.99，P＝0.005)；肿瘤位于升结肠52例，横结肠27例，降结肠19例，乙状结肠53例，直肠168例，其脉管侵犯率分别是28.85%(15/52)、7.41%(2/27)、10.53%(2/19)、20.75%(11/53)、36.90%(62/168)，差异具有统计学意义(χ²＝16.16，P＝0.003)。有淋巴结转移者脉管侵犯率为41.53%(49/118)，高于无淋巴结转移者21.39%(43/201)，差异具有统计学意义(χ²＝14.68，P＝0.000)。多因素分析显示T分期为T3、T4期(RR＝6.563，95%CI＝0.302～0.992，P＝0.047)和淋巴结转移(RR＝5.618，95%CI＝1.142～2.293，P＝0.007)是结直肠癌患者脉管侵犯的独立危险因素。全组319例患者中有297例获得随访，随访率为93.10%(297/319)，中位随访时间38(8～71)个月。全组患者5年生存率为55.56%(165/297)，其中脉管侵犯患者5年生存率为45.12%(37/82)，低于无脉管侵犯的59.53%(128/215)(χ²＝4.99，P＝0.025)。 结论T分期为T3、T4期、淋巴结转移的结直肠癌患者有较高的脉管侵犯风险，脉管侵犯可能提示结直肠患者预后不良。

Analysis of risk factors and prognosis on vascular invasion in patients with colorectal cancer

ObjectiveTo investigate the risk factors of vascular invasion in patients with colorectal cancer, and to explore the influence of vascular invasion on the prognosis. MethodsThe clinicopathological data of 319 patients with colorectal cancer who underwent radical resection from January 2010 to December 2013 in the Huaiyin People′s Hospital of Jinan were retrospectively analyzed, surgical specimens in all patients were collected and detected by immunohistochemical staining. The relationship between vascular invasion and clinicopathological factors of colorectal cancer were analyzed by chi square test or Fishers exact test. The influence of vascular invasion on overall survival was investigated with Kaplan-Meier curve, and the independent risk factors influencing vascular invasion were identified with Logistic regression. ResultsThe incidence of vascular invasion in patients with low differentiated tumor was 37.08%(33/89), which was significantly higher than that in those with middle-high differentiated tumor 25.65% (59/230), and the difference was statistically significant (χ²=4.08, P=0.043). Vascular invasion detection rate was higher in T3 (31.33%, 26/83) and T4 (34.09%, 60/176) group than those in T1 (11.11%, 1/9)and T2 (9.80%, 5/51)(χ²=12.99, P=0.005). Tumors of 52 cases located in the ascending colon, 27 cases in the transverse colon, 19 cases in the descending colon, 53 cases in the sigmoid colon, and 168 cases in the rectum, the vascular invasion rates were 28.85%(15/52), 7.41%(2/27), 10.53%(2/19), 20.75%(11/53), 36.90%(62/168) respectively, the difference was statistically significant(χ²=16.16, P=0.003). The incidence of vascular invasion in patients with lymph node metastasis was 41.53%(49/118), which was significantly higher than that in those without lymph node metastasis (21.39%, 43/201) (χ²=14.68, P=0.000). The results of multivariate analysis showed that T3, T4 state (RR=6.563, 95%CI=0.302-0.992, P=0.047) and lymph node metastasis (RR=5.618, 95%CI=1.142-2.293, P=0.007) were independent risk factors for vascular invasion in colorectal cancer patients. Among 319 colorectal cancer patients, 297 patients were followed up (93.10%) for 8-71 months, the median follow-up time was 38 months. The 5-year survival rate was 45.12% in patients with vascular invasion and 59.93% without vascular invasion, which was significantly different (χ²=4.99, P=0.025). ConclusionThe risk of vascular invasion is higher in colorectal cancer patients with T3, T4 state and lymph node metastasis, vascular invasion is a poor prognostic factor in colorctal cancer patients.