淋巴结阴性结肠癌伴同时性肝转移患者的临床病理因素分析*

目的：分析淋巴结阴性结肠癌患者发生同时性肝转移的危险因素，提高高危患者随访的效率和早诊率。方法：回顾性分析2008年1 月至2012年12月就诊北京肿瘤医院胃肠肿瘤中心并且行手术治疗的140 例淋巴结阴性结肠癌患者临床病理资料，通过单因素和多因素分析，研究淋巴结阴性结肠癌同期肝转移的高危因素。结果：140 例淋巴结阴性结肠癌患者同期肝转移13例（9.2%），61.5%（8/ 13例）的患者伴有不全性结肠梗阻，6 例患者接受原发灶和肝转移灶同期手术治疗。单因素分析和多因素分析均提示脉管浸润（P = 0.010）和术前CEA 水平异常（P = 0.004）是淋巴结阴性结肠癌患者发生同时性肝转移的独立危险因素。结论：淋巴结阴性结肠癌存在较高的同时性肝转移风险，脉管浸润和术前CEA 水平异常是这类患者发生同期肝脏转移的高危因素，对具有该特征的患者在就诊时或根治术后应该针对性地检查肝脏情况，避免漏诊。

Analysis of clinicopathological factors for node-negative colon cancer patients with synchronous liver metastases

Objective:To explore the clinicopathological factors in node-negative colon cancer patients with synchronous liver metasta-ses and to improve the efficiency of follow-up and rate of early diagnosis for high-risk patients. Methods:Clinical data of 140 colon cancer patients who underwent operation from January 2008 to December 2012 in Beijing Cancer Hospital were analyzed. The high-risk variables associated with synchronous liver metastases were subjected to univariate and multivariate analyses. Results:Synchro-nous liver metastases developed in 13 out of the 140 node-negative colon cancer patients. Eight out of those 13 patients (61.5%) ex-hibited complications with incomplete colon obstruction, and 6 cases underwent surgical treatment for both primary tumor and liver metastases. Both univariate and multivariate analyses revealed that preoperative abnormal serum carcinoembryonic antigen levels (≥5 ng/mL) and vascular invasion were significant independent risk factors for synchronous liver metastases. Conclusion:The risk of syn-chronous liver metastases for colon cancer patients with negative lymph node is slightly high. Vascular invasion and abnormal preoper-ative CEA levels are significant independent risk factors for synchronous liver metastases. Specific examination of livers is necessary for the special cohort at the time of diagnosis or after operation to avoid misdiagnosis.