结直肠癌淋巴结转移的多因素回归分析

目的探讨结直肠癌淋巴结转移规律及其影响因素，为临床诊断、治疗和预后评估提供参考。方法分类整理武汉大学中南医院1990年1月-2006年12月手术治疗的1127例结直肠癌病人的病历资料，采用χ^2检验及Logistic多因素回归分析方法，研究淋巴结转移与临床病理参数之间的相关性。结果单因素分析显示，患者的性别、肿瘤部位与淋巴结转移无明显相关性。影响淋巴结转移的因素有患者的年龄、肿瘤的大小、肿瘤浸润肠壁的深度、病理组织学类型和分化程度。40岁以下的结直肠癌患者淋巴结转移率明显高于40岁以上者（P〈0．01）；淋巴结转移率随肿瘤直径的增大而增加（P〈0．001）；肿瘤浸润肠壁的深度增加，淋巴结转移率增加（P〈0．001）；肿瘤的分化程度越低，淋巴结转移率越高（P〈0．001）。Logistic回归分析显示，结直肠癌淋巴结转移与病人的年龄、肿瘤的大小、肿瘤浸润肠壁的深度、肿瘤的分化程度相关，影响淋巴结转移的相关因素由强到弱依次为肿瘤浸润肠壁的深度、肿瘤的分化程度，在所选因素中肿瘤浸润肠壁的深度是影响淋巴结转移的最重要因素。结论结直肠癌淋巴结转移与病人的年龄、肿瘤的大小、肿瘤浸润肠壁的深度、病理组织学类型及分化程度相关，其中肿瘤浸润肠壁的深度是影响淋巴结转移的最重要因素。

Multivariate Regression Analyses on Metastatic Rules of Lymph Node in Colorectal Carcinoma

Objective To investigate the rules of lymphatic metastasis of colorectal carcinoma, in order to provide clinical basis for the diagnosis and treatment. Methods A retrospective analysis was performed in the 1127 patients with colorectal carcinoma who underwent surgical resection from January 1990 to December 2006 in Zhongnan Hospital. The associations between lymphatic metastasis and clinicopathologic variables were evaluated by Chi-squared test and logisticregression. Results Univariateanalysisindicated thatthe patients'sex and the location of the tumor were not factors influencing lymph node metastasis, and metastasis factors influencing lymph node meta-stasisincludedage,size ofthe tumor,degree ofinfiltration,histologicaltypeanddifferentiating degrees. Therate ofnode metastasis in patients aged below 40 was greater than that in the other groups (P< 0.01). The bigger the cancer grew the greater the rate of lymph node metastasis (P< 0.001). The deeper the cancer extended, the more chances lymph nodes metastasized (P< 0.001). Lymph node positive rate in poorly differentiated tumor was higher than that in well differen-tiated tumor (P<0.05). Logistic regression analysis showed that patients' age or tumor size were not important factors for the degree oflymphaticmetastasis while the degree oflymphaticmetastasis was relatedto the differentiating degrees and the depth of tumor invasion. The depth of tumor invasion was the major factor. Conclusion The lymphatic meta-stasis of colorectalcarcinoma is related to patients'age, tumor size, depth of tumor invasion and the differentiating de-gree of the tumor, depth of tumor invasion being the major factor.