[与T1和T2期直肠癌淋巴结转移相关的危险因素分析]

[Analysis of risk factors associate with lymph node metastasis of T1 and T2 rectal cancer].

作者信息

He Jian, Lou Zheng, Zhang Wei, Meng Ronggui, Fu Chuangang, Yu Enda, Wang Hao, Hao Liqiang, Wang Hantao

机构信息

Department of Anorectal Surgery, Changhai Hospital Affiliated to Second Military Medical University, Shanghai 200433, China.

出版信息

Zhonghua Wei Chang Wai Ke Za Zhi. 2015 Oct;18(10):1016-9.

PMID:26499148

Abstract

OBJECTIVE

To investigate the risk factors associated with lymph node metastasis of T1 and T2 rectal cancer.

METHODS

Clinicopathological data of 576 patients with stage T1 to T2 rectal cancer without serosal invasion confirmed by pathology undergoing curative resection in Changhai Hospital from January 1999 to December 2013 were analyzed retrospectively. The relationship of clinicopathological factors of overall patients and stage T1 patients with lymph node metastasis was analyzed by univariate or multivariate analysis.

RESULTS

The lymph node metastasis rate of stage T2 rectal cancer was significantly higher than that of stage T1[22.9% (108/463) vs. 9.7%(11/113), P=0.002], and the difference of stage T2a and T2b was not significant[22.0%(38/173) vs. 23.4% (68/290), P=0.733]. Multivariate analysis showed that poor differentiation(HR=1.54, 95% CI:1.12 to 2.13), abnormal carbohydrate antigen (CA) 199 level (HR=2.05, 95% CI:1.16 to 3.62), ulcerative mass (HR=1.58, 95% CI:1.05 to 2.39) and invasion of muscle (of inner ring muscle HR=3.55, 95% CI:1.79 to 7.02; of outer longitudinal muscle, HR=2.35, 95% CI:1.21 to 4.60) were independent risk factors of lymph node metastasis in patients with stage T1-T2 rectal cancer(all P<0.05). Meanwhile poor differentiation(HR=4.43, 95% CI:1.51 to 13.03), abnormal carcinoembryonic antigen(CEA) level (HR=4.66, 95% CI:1.18 to 20.11) and ulcerative mass (HR=6.23, 95% CI:1.51 to 25.66) were risk factors of lymph node metastasis in patients with stage T1 rectal cancer.

CONCLUSION

Poor differentiation, preoperative high CA199, ulcerated tumor, invasion of inner ring muscle or outer longitudinal muscle are risk factors of lymph node metastasis in patients with stage T1-T2 rectal cancer, while the invasion depth of muscularis propria is not risk factor. Besides, poor differentiation, abnormal CEA level, ulcerated tumor are risk factors of lymph node metastasis in stage T1 rectal cancer patients, which can be used as reference for local excision in patients with stage T1 rectal cancer.

摘要

目的

探讨T1和T2期直肠癌淋巴结转移的相关危险因素。

方法

回顾性分析1999年1月至2013年12月在长海医院接受根治性切除的576例经病理证实无浆膜侵犯的T1至T2期直肠癌患者的临床病理资料。采用单因素或多因素分析方法分析所有患者及T1期患者临床病理因素与淋巴结转移的关系。

结果

T2期直肠癌的淋巴结转移率显著高于T1期[22.9%（108/463）对9.7%（11/113），P = 0.002]，T2a期和T2b期之间的差异无统计学意义[22.0%（38/173）对23.4%（68/290），P = 0.733]。多因素分析显示，低分化（HR = 1.54，95%CI：1.12至2.13）、糖类抗原（CA）199水平异常（HR = 2.05，95%CI：1.16至3.62）、溃疡型肿块（HR = 1.58，9

5%CI：1.05至2.39）以及肌层浸润（内环肌浸润HR = 3.55，95%CI：1.79至7.02；外纵肌浸润，HR = 2.35，95%CI：1.21至4.60）是T1 - T2期直肠癌患者淋巴结转移的独立危险因素（均P < 0.05）。同时，低分化（HR = 4.43，95%CI：1.51至13.03）、癌胚抗原（CEA）水平异常（HR = 4.66，95%CI：1.18至20.11）和溃疡型肿块（HR = 6.23，95%CI：1.51至25.66）是T1期直肠癌患者淋巴结转移的危险因素。