结直肠癌肝转移相关临床病理危险因素分析

Analysis of clinicopathological risk factors of colorectal carcinoma related to liver metastases

目的分析与结直肠癌肝转移相关的临床病理学危险因素。方法收集2002年1月至2004年12月经手术切除原发灶、病理证实和完成随访的390例结直肠癌患者的临床病理资料。采用成组病例-对照研究法,将患者分为肝转移和无肝转移两组,选择肿瘤部位、大体类型、肿瘤长径、浸润周径、浸润深度、静脉癌栓、淋巴结转移位置、淋巴结转移数目和组织学类型等因素,用SAS6.12进行结直肠癌肝转移单因素分析和多因素Logistic回归分析,并对有意义的因素进行交互作用分析。结果单因素分析显示:结直肠癌浸润肠管壁的周径(P=0.022)、浸润深度(P=0.001)、静脉癌栓(P=0.001)、淋巴结转移位置(P=0.001)和肝转移相关;多因素分析显示:静脉癌栓(P=0.005)和淋巴结转移位置(P=0.001)和肝转移相关,静脉癌栓和淋巴结转移位置无交互作用。结论肿瘤浸润周径、浸润深度、静脉癌栓及淋巴结转移与发生结直肠癌肝转移密切相关,术后病理检查发现伴随有静脉癌栓及淋巴结转移的结直肠癌患者发生肝转移的危险性较大,而癌肿部位、大体类型、肿瘤长径、淋巴结转移数目和组织学类型与肝转移的发生无关。

Objective To explore the clinicopathological risk factors of colorectal carcinoma related to livermetastases. Methods The clinicopathologic records and the follow-up data of 390 patients with colorectal carcinoma undergoing operation between January 2002 and Dectember 2004 were collected to be analyzed retrospectively. All the patients were grouped into one with liver metastasis and one without liver metastasis. Thecollected clinicopathological features included location and size of tumor, pathological grade, histological type,infiltrating depth and circumference, venous cancerous embolus and lymph node metastasis. Univariate analysisand multinomial logistic regression （SAS6.12 for windows） and then correlation analysis were carried out toevaluate the factors concerned. Results Univariate analysis revealed that infiltrating circumference （P=0.022）,infiltrating depth and venous cancerous embolus （P=0.001）, lymph node metastasis （P=0.001） were related tohepatic metastasis. Multivariate analysis revealed that only venous cancerous embolus and lymph node metastasis were related to hepatic metastasis. The analysis of logistic regression illustrated that venous cancerous embolus did not interact with lymph node metastasis. Conclusion Our results showed that infiltrating depth andcircumference, venous cancerous embolus and lymph node metastasis are main factors related to liver metastasis from colonrectal carcinoma. Liver metastasis is easy to be found in patients with colorectal carcinoma inwhich the features are venous cancerous embolus and lymph node metastasis. But location and size of tumor,pathological grade and histological type do not relate with liver metastasis.