直肠癌淋巴结转移与临床病理特征分析

Analysis of lymph node metastasis and clinicopathological characteristics in rectal cancer

目的探讨直肠癌临床病理特征对淋巴结转移的影响。方法回顾性分析新疆医科大学附属肿瘤医院2007年1月至2009年12月收治的经手术治疗的210例直肠癌病人的临床病理资料,并比较不同因素对直肠癌淋巴结转移的影响。结果全组病例淋巴结转移率为30.5%,阳性淋巴结清除率为14.5%。性别、民族、年龄、肿瘤长径、侵犯周径、血清CEA、脉管瘤栓和肿瘤位置与直肠癌淋巴结转移无关(P>0.05)。单因素分析显示:浸润深度、组织类型、大体类型和分化程度与直肠癌淋巴结转移有关(P<0.05)。多因素分析表明:浸润深度、大体类型和分化程度是直肠癌淋巴结转移的独立危险因素(P<0.05)。逻辑回归分析显示,影响淋巴结转移强度的因素中:分化程度大于浸润深度;肿块型与溃疡型,肿块型与浸润型的淋巴转移差异有统计学意义(P<0.05)。结论大体类型、分化程度、组织类型和浸润深度是判断直肠癌生物学行为及淋巴结转移的有效方法;其中大体类型、分化程度和浸润深度是直肠癌淋巴结转移的独立危险因素;肿块型、溃疡型、浸润型的淋巴结转移风险依次增高。

Objective To investigate the effect of clinicopathological characteristics on lymph node metastasis in rectal cancer. Methods The clinicopathologieal data of 210 patients with rectal cancer performed operation between January 2007 and December 2009 in Affiliated Tumor Hospital of Xinjiang Medical University were analyzed retrospectively. The risk factors of lymph node metastasis were evaluated. Results The rate of lymph node metastasis in all patients was 30.5%. The clearance rate of positive lymph nods was 14.5%. The statistical analysis showed that there was no correlation between rectal cancer lymph node metastasis and gender, nationality, age, infiltration degree, CEA level, vessel tumor embolus, tumor size or site （P〉0.05）. The univariate analysis revealed that infiltration depth, tissue type, general categories and cell differentiation degree were related to the lymph node metastasis of rectal cancer. The multivarriate analysis demonstrated that infiltration depth, general categories and cell differentiation degree were independent factors predicting rectal cancer lymph node metastasis （P〈0.05）. The logistic regression analysis showed thai in all the factors affecting on intensity of lymph node metastasis, cell differentiation degree was greater than infiltration depth, and there were significant differences between mass type and ulceration type as well as between mass type and infiltration type（P〈0.05）. Conclusion General categories, cell differentiation degree, tissue type and infiltration depth can be used to evaluate the biological behaviors and lymph node metastasis of rectal cancer. And general categories, cell differentiation degree and infiltration depth are independent factors predicting rectal cancer lymph node metastasis. In the general types of rectal cancer, the risks of lymph node metastases in the types of mass, ulceration and infiltration are increased in turn.