结直肠癌肝转移相关的病理组织学评价

目的　探讨结直肠癌肝转移的病理组织学特性。　方法　对 335例行结直肠癌切除的患者作回顾性调查 ,将有肝转移者的病理组织学参数与无肝转移者对比。　结果　本组 4 1例 (1 2 % )有肝转移。有肝转移者与无肝转移者下列因素的百分率比较有显著性差异 :肿瘤大小超过 6cm(5 1 %vs2 8% ,P<0 .0 1 ) ,肠系膜浸润 (98%vs 6 6 % ,P <0 .0 1 ) ,淋巴管浸润 (34 %vs1 5 % ,P <0 .0 1 ) ,静脉浸润 (2 4 %vs3% ,P <0 .0 1 ) ,和淋巴结转移 (85 %vs 39% ,P <0 .0 1 )。多元回归分析提示 :与肝转移有关的独立因素是肠系膜浸润、静脉浸润和淋巴结转移。诊断肝转移的精确度最高的是静脉浸润 (88% ) ,最低的是系膜浸润 (4 1 % )。在 98例有肠系膜和淋巴结转移的患者中 ,有肝转移者与无肝转移者静脉浸润次数的差异非常显著 (2 6 %vs 6 % ,P <0 .0 1 ) ,肠外淋巴结转移次数的差异显著 (6 8%vs 4 7% ,P <0 .0 5 )。　结论　结直肠癌肝转移的重要因素是肠系膜侵润、静脉浸润和淋巴结转移 ,其决定因素是静脉浸润和肠外淋巴结转移。

Relative histopathologic evaluation of colorectal cancer with liver metastasis

Objective To study the histopathologic characteristics of colorectal cancer with liver metastasis. Methods A retropective histopathologic study on 335patients who underwent resection of colorectal cancer was performed .Histopathologic parameters of tumors in patients with and without liver metastasis were compared. Results Forty-one patients (12 percent) had liver metastasis.Tumors having liver metastasis,when compared with those not having live metastasis,were characterized by high frequency of tumor size more than 6 cm (51% vs 28%,P<0.01),presence of mesenteric invasion (98% vs 66%,P<0.01),lymphatic invasion (34% vs 15%,P<0.01), venous invasion (24% vs 3%,P<0.01);and lymph node metastasis (85% vs 39%, P<0.01). Multivariate dregression analysis showed that factors independently associated with liver metastasis were mesenteric invasion,venous invasion,and lymph node metastasis . Accuracy in the diagnosis of liver metastasis was highest for venous invasion(88percent)and lowest for mesenteric invasion (41 percert).Among 98 patients with both mesenteric invasion and lymph node metastasis,tumors with and without liver metastasis were different in frequency of venous invasion (26% vs 6%,P<0.01)and extracolic lymph node metastasis (68%vs 47%,P<0.05). Conclusion In colorectal cancer, important factors associated with liver metastasis are mesenteric invasion,venous invasion,and lymph node metastasis.Significant determinants for liver metastasis from colorectal cancer are venous invasion and extracolic lymph node metastasis.