结直肠癌淋巴结转移规律的多因素回归分析

Multiple Regression Analysis of Factors Related with Lymph Node Metastasis in Colorectal Cancer

目的:探讨结直肠癌淋巴结转移规律及其影响因素。方法:分类整理武汉大学中南医院1990年1月-2007年12月手术治疗的结直肠癌病人的病历资料1 127例,采用卡方检验及Logistic多因素回归分析方法研究淋巴结转移与临床病理参数之间的相关性。结果:单因素分析显示,患者的性别、肿瘤部位与淋巴结转移无明显相关性。影响淋巴结转移的因素有患者的年龄、肿瘤的大小、肿瘤浸润肠壁的深度和分化程度。40岁以下的年轻结直肠癌患者淋巴结转移率明显高于40岁以上者(P<0.01)。淋巴结转移率随肿瘤直径的增大而增高(P<0.001)。肿瘤浸润肠壁的深度增加,淋巴结转移率增加(P<0.001)。肿瘤的分化程度越低,淋巴结转移率越高(P<0.001)。Logistic多因素回归分析显示,结直肠癌淋巴结转移与肿瘤浸润肠壁的深度和肿瘤的分化程度相关,相关因素与淋巴结转移的程度依次为肿瘤浸润肠壁的深度>肿瘤的分化程度,在所选因素中肿瘤浸润肠壁的深度是影响淋巴结转移的最重要因素。结论:结直肠癌淋巴结转移与肿瘤浸润肠壁的深度和分化程度相关,其中肿瘤浸润肠壁的深度是影响淋巴结转移的最重要因素。

To investigate the relationship between characteristics of lymph node metastasis in colorectal cancer and its related factors. Methods： A total of 1127 cases of colorectal carcinoma undergone resection from Jan 1990 to Dec 2007 were retrospectively studied. The associations between lymph node metastasis and clinicopathologic variables such as age, gender, tumor location, size, depth of tumor invasion, and grade of histological differentiation were evaluated univariately using chi-squared test and multivariately using logistic regression analysis. Results： Univariate logistic regression analysis showed that the tumor size, depth of invasion and histological differentiation were statistically significant as risk factors for lymph node metastasis in colorectal cancer. The cases of lymph node metastasis in the patients （age〈40 years） was significantly higher than in the older patients （age〈40 years） （P〈0.01）. The risk of lymph node metastasis correlated significantly with the tumor diameter （P〈0. 001）, depth of tumor invasion （P〈0. 001） and poor tumor histological differentiation （P〈0. 001）. Multivariate logistic regression analysis revealed that the significant risk factors of lymph node metastasis included depth of tumor invasion and grade of histological differentiation, while the former was the most important one among all clinicopathologic variables. Conclusion： Depth of tumor invasion and grade of histological differentiation are significantly correlated with lymph node metastasis in eolorectal cancer. The histological differentiation is the most important predictive factor of lymph node metastasis among all clinicopathologic variables.