T1、T2期直肠癌发生淋巴结转移及其相关危险因素分析

Lymph node metastasis and its risk factors in T1-2 staging invasive rectal carcinoma

目的 研究探讨T1、T2期直肠癌发生淋巴结转移情况,并分析与其相关的危险因素.方法 对2000年1月至2009年4月收治的所有接受根治性手术的原发性直肠癌患者1116例（TNM分期I～Ⅲ期）的临床资料进行回顾性研究,分析与T1、T2期直肠癌淋巴结转移相关的危险因素.研究因素为临床常用可对肿瘤进行客观评价的因素.统计分析采用Logistic多因素回归分析和x2检验.结果 共1116例直肠癌患者入组,其中T1、12期直肠癌为358例（32.1%）.T1和T2期直肠癌发生淋巴结转移的比例分别为5.6%（2/36）和23.3%（75/322）.T1、T2期肿瘤发生淋巴结转移比例（21.5%,77/358）明显低于T3、T4期肿瘤（51.6%,391/758）（P〈0.05）.进一步分析发现,仅肿瘤T分期是与T1、T2期直肠癌发生淋巴结转移相关的独立危险因素（OR：5.162;95%C/：1.212～21.991;P=0.026）.结论 T1、T2期直肠癌发生淋巴结转移风险较高,且在各种常规临床病理指标中无预测淋巴结转移的危险因素,提示当前应进一步研究T1、T2期直肠癌淋巴结转移的高危因素,以指导治疗方式选择.

Objective To investigate the lymph node metastasis and its risk factors in T1-2 staging invasive rectal carcinoma. Methods The data of 1116 patients with rectal cancer treated with total mesoreetal excision （TME） technique from January 2000 to April 2009 was analyzed retrospectively. The clinicopathological factors analyzed included gender, age, primary symptom type, number of symptoms, duration of symptom, synchronous polyps, preoperative serum carcino-embryonic antigen level, preoperative serum CA19-9 level, the distance of tumor from the anal verge, tumor size, tumor morphological type, tumor circumferential extent, tumor differentiation and tumor T staging. Statistical analysis was performed by using Logistic regression analysis and Chi-square test. Results A total of 1116 patients were enrolled, and 358 cases （32. 1% ） were classified as with TI-2 staging tumor. Two cases （5. 6%, 2/36） in patients with a TI staging tumor were found with lymph node metastasis, and 75 cases （23.3%, 75/322） in patients with a T2 staging tumor, respectively. Compared with patients with T3-4 staging tumor, lymph node metastasis rate of the patients with T1-2 staging tumor was significantly lower[21.5% （77/358） vs. 51.6% （391/758）, P 〈 0. 05 ]. Only the tumor T staging was found as the independent risk factor for the lymph node metastasis in patients with T1-2 staging tumor on multivariate Logistic regression analysis （odds ratio：5. 162; 95% CI： 1. 212 to 21. 991 ; P =0. 026）. Conclusions A substantial proportion of T1-2 staging rectal cancers harbor metastatic lymph nodes and the clinicopathological features except for T staging fail to predict the lymph node metastasis. Further research is warranted to identify the risk factors and guide the clinical practice in patient with T1-2 staging tumor.