摘要
目的研究Ⅰ~Ⅱ期直肠癌肝转移的相关临床病理因素,为临床治疗提供依据,以期降低肝转移率,提高早期直肠癌的术后生存率。方法Ⅰ~Ⅱ期直肠癌术后并异时性肝转移病例92例,建立数据库。选择TMN分期、组织类型、癌胚抗原、血管侵袭、手术方式、直肠系膜环周切缘等临床病理因素,用单因素和多因素Logistic回归进行分析,筛选出肝转移的相关高危因素,建立预警模型。结果单因素分析显示,早期直肠癌异时性肝转移的相关因素有：血管侵袭、组织病理类型、肿瘤部位、肠壁内浸润深度、TMN分期、肠腔内浸润范围、术后辅助治疗、直肠系膜环周切缘、微血管密度、组织学分级;而性别、年龄、癌胚抗原、手术方式则与肝转移无显著相关性。多因素分析显示,病理组织类型、血管侵袭、肠壁内浸润深度、术后辅助治疗、微血管密度、直肠系膜环周切缘是影响肝转移的独立因素。结论早期直肠癌患者病理类型为高度恶性潜能、T4分期、微血管密度升高、有血管侵袭者或直肠系膜环周切缘阳性者易发生肝转移,术后应予严密随访,进行个体化辅助治疗,以降低肝转移发生率。
Objective To investigate the clinical factors for hepatic metastasis of rectal carcinoma at stage Ⅰ- Ⅱ. Methods Three hundred and eighty cases of rectal cancer were collected to set up the database. Binary and multinomial logistic regression was employed to indicate the independent factors relating to hepatic metastasis, the regression equation to predict probability of liver metastasis of rectal cancer. Results Multivariate analysis revealed that blood vessel invade （BVI）, TMN stage, type of pathology, microvessel density （MDV）, adjuvment therapy and circumferential margin involvement （CMI） were independent indicators of the probability of hepatic metastasis of rectal carcinoma at stage Ⅰ-Ⅱ Conclusion Patients with early stage rectal cancer, which is complicated with BVI, advanced T phase, high preoperative level MVD, CMI or poor differentiation degree, are apt to develop liver metastasis. They should be given further individualized intensive adjuvant treatment.
出处
《福建医科大学学报》
2009年第6期471-475,共5页
Journal of Fujian Medical University
基金
福建省自然科学基金(2009J01147)
关键词
直肠肿瘤
肝肿瘤
肿瘤转移
回归分析
rectal carcinoma
hepatic neoplasms/secondary
logistic regression
