结直肠癌肝转移相关的病理组织学评价

Relative histopathologic evaluation of colorectal cancer with liver metastasis

目的:探讨结直肠癌肝转移的病理组织学特性。方法:对335例行结直肠癌切除的患者行回顾性病理组织学研究,将有肝转移者的病理组织学参数与无肝转移者对比。结果:本组41例(12％)有肝转移,有肝转移者与无肝转移者诸因素的百分率比较为:肿瘤大小超过6cm(51％vs28％;P<0.01),肠系膜浸润(98％vs66％;P<0.01),淋巴管浸润(34％vs15％;P<0.01),神经浸润(24％bs3％;P<0.01),和淋巴结转移(85％vs39％;P<0.01)。多元回归分析展示:与肝转移有关的独立因素是肠系膜浸润、静脉浸润和淋巴结转移。诊断肝转移的精度最高的是静脉浸润(88％),最低的是系膜浸润(41％)。在98例有肠系膜和淋巴结转移者中,有肝转移者与无肝转移者静脉浸润次数差异非常显著(26％vs6％;P<0.01),其肠外淋巴结转移次数差异显著(68％vs47％;P<0.05)。结论:结直肠癌肝转移的重要因素是肠系膜浸润,静脉浸润和淋巴结转移。其决定因素是静脉浸润和肠外淋巴结转移。

Objective: To study the histopathologic characteristics of colorectal cancer with liver metastasis. Mothods: We performed a retrospective histopathologic study on 335 patients who underwent re- section of colorectal cancer. Histopathologic parameters of tumors with liver metastasis. Results: Forty-one patients(12 percent) had liver metastasis. Tumors having liver metastasis, when compared with those not having live metastasis, were characterized by high frequency of tumor size mare than 6 cm(51 vs 28 percent; P>0.01 ), presence of serosal invasion (98 vs 66 percent; P<0.01), venous invasion ( 24 vs 3 percent; P <0.01), and lymph node metastasis ( 85 vs 39 percent; P<0.01). Multivariate regression analysis showed that factors independently associated with liver metastasis were serosal invasion, venous invasion, and lymph node metastasis. Accuracy in the diagnosis of liver metastasis was highest for venous invasion (88 percent)and lowest for serosal invasion (41 percert). Among 98 patients with both serosal invasion and lymph node metastasis, tumors with and without liver metastasis were different in frequency of venous invasion (26 vs 6 percent; P<0.01) and extracolic lymph node metastasis (68 vs 47 percent; P<0.05). Conclusion: In colorectal cancer important factors assoctiated with liver metastasis were serosal invasion, venous invasion, and lymph node metastasis. Significant determinants for liver metastasis from colorectal concer were venous invasion and extracolic lymph node metastasis.