Ⅰ～Ⅲ期结直肠癌根治术后转移的多因素分析

Multivariate analysis of metastasis in stage Ⅰ～Ⅲ colorectal cancer following radical surgery

目的:探讨Ⅰ～Ⅲ期结直肠癌根治术后发生远处转移的危险因素。方法:回顾性分析2003年3月-2009年6月Ⅰ～Ⅲ期结直肠癌患者288例,收集患者性别、年龄、肿瘤部位、肿瘤大小、浸润深度、分化程度、术前白蛋白、术前血清癌胚抗原、术前血红蛋白、淋巴结转移等临床病理资料,分析各临床病理因素与术后远处转移率的相关性和术后远处转移的独立危险因素。结果:Ⅰ～Ⅲ期结直肠癌根治术后转移率术前血清癌胚抗原≥10μg/L组明显高于﹤10μg/L组,有淋巴结转移组明显高于无淋巴结转移组(P均﹤0.01)。淋巴结转移阳性(比值比2.37,95%CI为1.19～4.72,P﹤0.01)、术前血清癌胚抗原≥10μg/L(比值比3.34,95%CI为1.69～6.62,P﹤0.01)是发生术后远处转移的独立危险因素。结论:淋巴结转移阳性、术前血清癌胚抗原≥10μg/L的Ⅰ～Ⅲ期结直肠癌患者根治术后要加强随访和复查。

Objective：To explore the risk factors of metastasis in stage Ⅰ~Ⅲ colorectal cancer following radical surgery.Methods：Two hundred and eighty eight cases with stage Ⅰ~Ⅲ colorectal cancer from March 2003 to June 2009 were analyzed retrospectively.The clinicopathological data were collected,including sex,age,tumour location,tumour size,depth of invasion,differentiation,preoperative albumin,preoperative serum carcinoembryonic antigen,preoperative hemoglobin and lymph node metastasis rate.The association between the clinicopathological factors and the rate of metastasis following radical surgery was analyzed.The independent risk factors of metastasis were analyzed.Results：The rate of postoperative metastasis was higher in the group with preoperative serum carcinoembryonic antigen level higher than 10 μg/L and in lymph node metastasis-positive group（P﹤0.01）.Lymph node metastasis（hazard ratio 2.37,95 % CI 1.19~4.72,P﹤0.01） and high level of preoperative serum carcinoembryonic antigen（≥10 μg/L,hazard ratio 3.34,95 % CI 1.69~6.62,P﹤0.01） were independent risk factors for metastasis in stage Ⅰ~Ⅲ colorectal cancer following radical surgery.Conclusion：Colorectal cancer cases with lymph node metastasis and higher level of preoperative serum carcinoembryonic antigen（≥10 μg/L） should receive careful and active postoperative follow-up and re-examination.