结直肠癌确诊时合并肝转移危险因素分析

Risk Factors Analysis of Patients with Hepatic metastases from Colorectal Cancer

目的:分析结直肠癌确诊时合并肝转移的临床和病理危险因素,为结直肠癌肝转移的早期诊断和进一步治疗提供参考。方法:对2006年1月—2008年6月宁波市第一医院普外科收治的247例结直肠癌手术患者临床和病理资料进行回顾分析,根据术前检查和术中探查,分为合并肝转移组与无肝转移组,用单因素和多因素回归分析方法分析两组的年龄、性别、有无肝炎病史、肝功能指标、肿瘤指标、肿瘤部位、浸润深度、淋巴结有无转移、肿瘤标本巨检和分化程度、是否合并急性肠梗阻等与肝转移的相关性,从而得出肝转移的相关危险因素。结果:247例患者中有22例合并肝转移,占8.9%。单因素分析提示,结直肠癌确诊时合并肝转移的危险因素有:女性患者、有急性肠梗阻、盆腔腹膜或大网膜有转移结节、低或未分化肿瘤、肿瘤大小和浸润程度及术前血清CEA水平。多因素Logistic回归分析表明,肿瘤浸润深度、区域淋巴结转移、术前血CEA水平、肿瘤标本巨检、腹膜和大网膜转移结节与肝转移密切相关。术前血清CEA大于27.75ng·mL-1结直肠发生肝转移的发生率明显增高。结论:结直肠癌确诊时合并肝转移与肿瘤浸润深度、区域淋巴结有无转移、术前血CEA、肿瘤标本巨检、腹膜及大网膜转移结节相关。

Objective：To analyze the clinicopathological risk factors of patients with hepatic metastasis from colorectal cancer. Methods： Clinicopathological data of 247 cases with colorectal cancer from January 2006 to June 2008 in the No.1 Ningbo Hospital were collected.Patients were divided into two groups according to hepatic metastases or not. Single and multiple factors anaiysis approach were adopted to analyze risk factors, such as age, sex, hepatitis history, liver functional parameter, primary tumor position, infiltration depth, lymphoid node metastasis, tumor appearance, cell differentiation degree, acute ileus etc. Results： There were 22 cases with hepatic metastases, accounting for 8.9%.Single factor analysis showed that female, acute ileus, pelvic peritoneum or omentum metastases node, poorly differentiated or undifferentiation,tumor size,infiltration depth were related to hepatic metastasis. Logistic regression analysis showed that infiltration depth, lymph node matastasis, tumor appearance, pre-operation serum CEA level, peritoneal or omentum metastases had statistical significance between two groups. ROC curve showed pre-operation serum CEA level exceed 27.75 ng·mL^-1,the incidence rate of hepatic metastases obviously increased.Conclusion：The tumor appearance, infiltration depth, lymph node metastasis, pre-operation serum CEA level, peritoneal or omentum metastasis were associated with metastases.