[结直肠癌根治术后5年内骨转移危险因素分析]

Li Ang, Tan Zhen, Fu Chuangang, Wang Hao, Yuan Jie

Department of Colorectal Surgery, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China.

Zhonghua Wei Chang Wai Ke Za Zhi. 2017 Jan 25;20(1):58-61.

OBJECTIVE

To investigate the risk factors of metachronous bone metastasis after radical resection of colorectal cancer within 5 years.

METHODS

Clinical data of 1 749 patients with colorectal cancer, of whom 50(2.8%) patients developed metastasis to bone after operation, in the Department of Colorectal Surgery, Changhai Hospital of The Second Military Medical University from January 2001 to December 2010 were analyzed retrospectively. Univariate and multivariate analysis were performed to find the risk factors of metachronous bone metastasis from colorectal cancer using Chi square test and Logistic regression, respectively.

RESULTS

Of 50 colorectal cancer cases with bone metastasis, 29 were male and 21 were female. The age was ≥ 60 years old in 28 cases. Tumors of 36 cases were located in the rectum and of 14 cases located in the colon. Pathology examination showed 43 cases were adenocarcinomas, 7 cases were mucinous adenocarcinoma. Forty-two cases had T3-4 stage lesions, 30 cases had lymph node metastasis, 14 cases had pulmonary metastasis, and 5 cases had liver metastasis. Univariate Chi square test indicated that factors associated with the metachronous bone metastasis of colorectal cancer within 5 years were tumor site (χ=4.932, P=0.026), preoperative carbohydrate antigen 199 (CA199) level (χ=4.266, P=0.039), lymph node metastasis (χ=13.054, P=0.000) and pulmonary metastasis(χ=35.524, P=0.000). The incidence of bone metastasis in patients with rectal cancer (3.6%, 36/991) was higher compared to those with colon cancer (1.8%, 14/758). The incidence of bone metastasis in patients with higher(> 37 kU/L) preoperative serum CA199 level (4.9%, 12/245) was higher compared to those with lower serum CA199 level (2.5%, 38/1504). The incidence of bone metastasis in patients with lymph node metastasis(4.8%,30/627) and pulmonary metastasis (11.6%, 14/121) was significantly higher compared to those without lymph node metastasis (1.8%, 20/1122) and pulmonary metastasis(2.2%, 36/1628), respectively. Logistic multivariate analysis showed that rectal cancer(OR:0.508, 95%CI:0.268 to 0.963, P=0.038), lymph node metastasis (OR:2.291, 95%CI:1.273 to 4.122, P=0.006) and metachronous pulmonary metastasis(OR:4.796, 95%CI:2.473 to 9.301, P=0.000) were the independent risk factors of metachronous bone metastasis of colorectal cancer within 5 years.

CONCLUSION

Patients with rectal cancer, lymph node metastasis and metachronous pulmonary metastasis are high risk groups of metachronous bone metastasis after radical resection of colorectal cancer within 5 years.

目的

探讨结直肠癌根治术后5年内异时性骨转移的危险因素。

方法

回顾性分析2001年1月至2010年12月在第二军医大学长海医院结直肠外科收治的1749例结直肠癌患者的临床资料，其中50例（2.8%）术后发生骨转移。分别采用卡方检验和Logistic回归进行单因素和多因素分析，以寻找结直肠癌异时性骨转移的危险因素。

结果

50例发生骨转移的结直肠癌患者中，男性29例，女性21例。年龄≥60岁者28例。肿瘤位于直肠36例，位于结肠14例。病理检查显示腺癌43例，黏液腺癌7例。42例为T3-4期病变，30例有淋巴结转移，14例有肺转移，5例有肝转移。单因素卡方检验表明，与结直肠癌术后5年内异时性骨转移相关的因素有肿瘤部位（χ=4.932，P=0.026）、术前糖类抗原199（CA199）水平（χ=4.266，P=0.039）、淋巴结转移（χ=13.054，P=0.000）和肺转移（χ=35.524，P=0.000）。直肠癌患者（3.6%，36/991）骨转移发生率高于结肠癌患者（1.8%，14/758）。术前血清CA199水平较高（>37 kU/L）的患者（4.9%，12/245）骨转移发生率高于血清CA199水平较低的患者（2.5%，38/1504）。有淋巴结转移（4.8%，30/627）和肺转移（11.6%，14/121）的患者骨转移发生率分别显著高于无淋巴结转移（1.8%，20/1122）和无肺转移（2.2%，36/1628）的患者。Logistic多因素分析显示，直肠癌（OR：0.508，95%CI：0.268至0.963，P=0.038）、淋巴结转移（OR：2.291，95%CI：1.273至4.122，P=0.006）和异时性肺转移（OR：4.796，95%CI：2.473至9.301，P=0.000）是结直肠癌术后5年内异时性骨转移的独立危险因素。