Dukes'C 期结直肠癌异时性肝转移相关因素分析*

目的：探讨影响结直肠癌异时性肝转移的临床病理相关因素。方法：收集2003年1 月～2006年12月的所有Dukes'C期手术患者的临床病理及随访资料。选择性别、年龄、肿瘤大小、组织学类型、肠壁浸润程度、血清CEA 水平等因素作为研究对象。采用非条件Logistic回归单因素分析，对有统计学意义的变量进行非条件Logistic回归多因素分析。结果：随访170 例Dukes'C期患者36例（21.2%）出现异时性肝转移，其中26例（72.2%）发生于术后2 年内，32例（88.9%）发生于术后3 年内。单因素分析示肠壁浸润层次、组织学类型和血清CEA 是异时性肝转移的相关因素。性别、年龄、肿瘤大小、分化程度等与肝转移无相关性。多因素分析显示肿瘤浸润程度、血清CEA 水平是异时性肝转移的独立危险因素，组织学类型是独立保护性因素。结论：肿瘤浸润程度、组织学类型和血清CEA 是异时性肝转移的独立相关因素。结直肠癌根治术后2～3 年内密切随访，特别是术前CEA 值高于正常，肿瘤浸润达浆膜或浆膜外的Dukes'C期患者，早期发现异时性肝转移显得尤为必要。

Analysis of Related Factors of Metachronous Liver Metastases in Patients with Dukes'C Colorectal Cancer

Objective: To investigate the clinical and pathological factors related to metachronous liver metastases in patients with Dukes'C colorectal cancer.Methods: A total of 170 patients with Dukes'C colorectal cancer treated with radical surgery in our hospital between January 2003 and December 2006 were reviewed.Factors including sex, age, tumor size (cm), depth of invasion, histological type, and serum CEA level were analyzed.Univariate and multivariate analyses were used to evaluate the factors concerned by Binary logistic regression (SPSS 13.0 for windows).Results: Of the 170 cases, 36 cases had metachronous liver metastases and 26 of them (72.2%) were found with metachronous liver metastases with-in two years after surgery.Thirty-two cases (88.9%) were identified with metachronous liver metastases within three years after surgery.Univariate analysis showed that depth of invasion, histological type and serum CEA level were predictors that could affect metachronous liver metastases.Depth of invasion and serum CEA level were independent risk factors for meta-chronous liver metastases of colorectal cancer.Multivariate analysis revealed that histological type was independent favor-able factor for metachronous liver metastases of colorectal cancer.Conclusion: Depth of invasion, histological type and se-rum CEA level were independent factors related to metachronous liver metastases of colorectal cancer.It is necessary to closely follow up Dukes'C colorectal cancer patients for two or three years after surgery in order to detect metachronous liv-er metastases early, especially for patients with higher preoperative serum CEA level or with tumor invasion to serosa.