直肠癌淋巴结转移相关因素的临床探讨

Relevant factors of lymphatic metastasis in rectal carcinoma

目的：探讨直肠癌淋巴结转移的规律，为临床治疗提供参考。方法：对1995～2004年手术治疗的979例直肠癌的资料进行分类整理，采用卡方检验及logistic多因素回归分析了解其淋巴结转移与临床病理之间的关系。结果：30岁以下年龄组的淋巴结转移率为71．4％；肿瘤直径大于6cm组的淋巴结转移率为40．7％；肿瘤浸润至浆膜外组的淋巴结转移率为82．5％；低分化腺癌、黏液腺癌、印戒细胞癌组淋巴结转移率分别为71．6％，70．4％，100％；肿瘤侵犯肠管周径大于1／2者淋巴结转移率为46．4％。logistic多因素回归分析表明，相关因素与淋巴结转移的程度依次为：分化程度〉浸润深度〉侵犯肠管周径，分化程度是影响淋巴结转移的最重要因素。结论：直肠癌淋巴结转移与病人年龄、肿瘤大小、侵犯肠管周径、浸润深度和分化程度相关，其中肿瘤的分化程度是影响淋巴结转移的最重要因素。

Objective To investigate the rules of lymphatic metastasis of rectal carcinoma, and to help clinical diagnosis and treatment. Methods A retrospective analysis was performed in the 979 patients with rectal carcinoma who underwent surgical resection from 1995 to 2004. The associations between lymphatic metastasis and clinicopathologic variables were evaluated by Chi-squared test and logistic regression. Results The rate of lymph node metstasis was 71.4% for patients younger than 30 years old, 40.7% in the patients with tumor diameters over 6 centimeters, 82.5% in the patients with extraneous tumor invasion, 71.6% for patients of poor-differentiated adenocarcinoma, 70.4% for patients with mucoid adenocarcinoma, 100% for patients with signet-ring cell carcinoma and 46.4% for patients with more than half intestinal circumference invasion. Logistic regression analysis showed that the degree of lymphatic metastasis was related to the differentiating degrees, depths of tumor invasion and intestinal circumference invasion, and the differentiating degree was the major factor. Conclusion The lymphatic metastasis of rectal carcinoma is related to age, tumor size, intestinal circumference invasion, depth of tumor invasion and the differentiating degree of the tumor; the differentiating degree is the major factor.