Wang Renjie, Wu Peng, Shi Debing, Zheng Hongtu, Huang Liyong, Gu Weilie, Xu Ye, Cai Sanjun, Cai Guoxiang
Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
PLoS One. 2014 Nov 19;9(11):e111770. doi: 10.1371/journal.pone.0111770. eCollection 2014.
The aim of the study is to identify the risk factors of synchronous ILN metastasis for lower rectal cancer involving the anal canal.
Patients with lower rectal cancer who underwent radical resection at the Fudan University Shanghai Cancer Center were retrospectively analyzed. The synchronous ILN metastasis was defined as the metastasis occurring within 6 months after the diagnosis of rectal cancer. Patients' gender, age, tumor diameter, dentate line invasion, differentiation level, histological type, depth of invasion, perirectal LN metastasis, lymphovascular invasion or perineural invasion were analyzed in the study. The correlation between synchronous ILN involvement and clinicopathological features were analyzed with Chi-square test/fisher's exact test. Variables with p<0.05 in univariate analysis were then analyzed in a multivariate logistic model. Odds ratio (OR) along with 95% confidence intervals (95% CI) were calculated.
A total of 325 patients (182 men and 143 women) with lower rectal cancer met the criteria and were enrolled in the study. Among them, 20 patients (6.2%) had synchronous ILN metastasis. Both univariate and multivariate analysis showed the invasion of the dentate line had a strong correlation with synchronous ILN metastasis with the odds ratio (OR) of 23.558 [95% confidence interval (CI) 6.380-86.982] (p<0.001). The presence of lymphovascular invasion also showed a significant correlation synchronous ILN metastasis with odds ratio (OR) of 5.260 [95% confidence interval (CI) 1.818-15.212] (p = 0.002).
The invasion of dentate line and lymphovascular invasion are two independent risk factors of inguinal lymph node metastasis for lower rectal cancer involving the anal canal.
本研究旨在确定累及肛管的低位直肠癌同步髂内淋巴结转移的危险因素。
对在复旦大学附属上海肿瘤医院接受根治性切除术的低位直肠癌患者进行回顾性分析。同步髂内淋巴结转移定义为在直肠癌诊断后6个月内发生的转移。研究分析了患者的性别、年龄、肿瘤直径、齿状线侵犯、分化程度、组织学类型、浸润深度、直肠周围淋巴结转移、淋巴管侵犯或神经周围侵犯情况。采用卡方检验/费舍尔精确检验分析同步髂内淋巴结受累与临床病理特征之间的相关性。单因素分析中p<0.05的变量随后在多因素逻辑模型中进行分析。计算比值比（OR）及95%置信区间（95%CI）。
共有325例低位直肠癌患者（男性182例，女性143例）符合标准并纳入研究。其中，20例（6.2%）发生同步髂内淋巴结转移。单因素和多因素分析均显示齿状线侵犯与同步髂内淋巴结转移密切相关，比值比（OR）为23.558[95%置信区间（CI）6.380 - 86.982]（p<0.001）。淋巴管侵犯的存在也与同步髂内淋巴结转移显著相关，比值比（OR）为5.260[95%置信区间（CI）1.818 - 15.212]（p = 0.002）。
齿状线侵犯和淋巴管侵犯是累及肛管的低位直肠癌腹股沟淋巴结转移的两个独立危险因素。
