Gao Chun, Li Jing-Tao, Fang Long, Wen Si-Wei, Zhang Lei, Zhao Hong-Chuan
Department of Gastroenterology, China-Japan Friendship Hospital, Ministry of Health, Beijing, China E-mail :
Asian Pac J Cancer Prev. 2013;14(11):6293-9. doi: 10.7314/apjcp.2013.14.11.6293.
A number of clinicopathologic factors have been found to be associated with pathological lymph node metastasis (pLNM) in rectal cancer; however, most of them can only be identified by expensive high resolution imaging or obtained after surgical treatment. Just like the Child-Turcotte-Pugh (CTP) and the model for end-stage liver disease (MELD) scores which have been widely used in clinical practice, our study was designed to assess the pre-operative factors which could be obtained easily to predict intra-operative pLNM in rectal cancer.
A cohort of 469 patients who were treated at our hospital in the period from January 2003 to June 2011, and with a pathologically hospital discharge diagnosis of rectal cancer, were included. Clinical, laboratory and pathologic parameters were analyzed. A multivariate unconditional logistic regression model, areas under the curve (AUC), the Kaplan-Meier method (log-rank test) and the Cox regression model were used.
Of the 469 patients, 231 were diagnosed with pLNM (49.3%). Four variables were associated with pLNM by multivariate logistic analysis, age<60 yr (OR=1.819; 95% CI, 1.231-2.687; P=0.003), presence of abdominal pain or discomfort (OR=1.637; 95% CI, 1.052-2.547; P=0.029), absence of allergic history (OR=1.879; 95% CI, 1.041-3.392; P=0.036), and direct bilirubin ≥ 2.60 μmol/L (OR=1.540; 95% CI, 1.054-2.250; P=0.026). The combination of all 4 variables had the highest sensitivity (98.7%) for diagnostic performance. In addition, age<60 yr and direct bilirubin ≥ 2.60 μmol/L were found to be associated with prognosis.
Age, abdominal pain or discomfort, allergic history and direct bilirubin were associated with pLNM, which may be helpful for preoperative selection.
已发现许多临床病理因素与直肠癌的病理淋巴结转移（pLNM）相关；然而，其中大多数因素只能通过昂贵的高分辨率成像来识别，或者在手术治疗后才能获得。就像在临床实践中广泛应用的Child-Turcotte-Pugh（CTP）和终末期肝病模型（MELD）评分一样，我们的研究旨在评估那些易于获取的术前因素，以预测直肠癌术中的pLNM。
纳入2003年1月至2011年6月期间在我院接受治疗且出院病理诊断为直肠癌的469例患者。对临床、实验室和病理参数进行分析。使用多变量无条件逻辑回归模型、曲线下面积（AUC）、Kaplan-Meier方法（对数秩检验）和Cox回归模型。
469例患者中，231例被诊断为pLNM（49.3%）。多变量逻辑分析显示，4个变量与pLNM相关，年龄<60岁（OR=1.819；95%CI，1.231-2.687；P=0.003）、存在腹痛或不适（OR=1.637；95%CI，1.052-2.547；P=0.029）、无过敏史（OR=1.879；95%CI，1.041-3.392；P=0.036）以及直接胆红素≥2.60μmol/L（OR=1.540；95%CI，1.054-2.250；P=0.026）。这4个变量联合使用时诊断性能的灵敏度最高（98.7%）。此外，年龄<60岁和直接胆红素≥2.60μmol/L与预后相关。
年龄、腹痛或不适、过敏史和直接胆红素与pLNM相关，这可能有助于术前筛选。
