影响大肠癌淋巴结转移的因素间相关性探讨

Relationship between related factors with lymph node metastasis of colorectal cancer

目的研究影响大肠癌淋巴结转移的各种临床及病理因素之间的关系,为临床诊断及治疗提供参考.方法收集我院1975/1999年间手术治疗的大肠癌1374例,对全部病例及随访资料进行分析,建立 ACCESS 数据库,进行检索,采用排列组合的方法,逐个分析年龄、浸润深度、侵犯肠管周径、病理类型、分化程度、生长方式、肿瘤部位之间的相关性.统计方法采用行×列表资料的 X^2检验.结果小于30岁年龄组大肠癌浸润肠管周径较其他年龄组高,其粘液腺癌、印戒细胞癌所占比例分别为22.7%(17/75),14.7%(11/75),较其他年龄组均多(P=0.000 X^2=72.22);与肿瘤浸润肠管周径有关的因素有肿瘤浸润肠壁深度(P=0.000 X^2=353.58),肿瘤生长方式(P=0.000X^2=155.35),肿瘤分化程度(P=0.035 X^2=13.53)肿瘤病理类型(P=0.000 X^2=31.64),肿瘤部位(P=0.000X^2=44.73);粘液腺癌及印戒细胞癌浸润至浆膜层的比例为81.6%(120/147)和86.36%(19/22)显著高于腺癌组67.7%(574/848);分化程度低的肿瘤及浸润性生长的肿瘤其浸润肠壁的深度增高;直肠癌及乙状结肠癌浸润到肠壁外的比例分别为要较其他组低(P=0.000 X^2=36.96).升结肠,横结肠,降结肠癌中粘液腺癌所占比例均较乙状结肠及直肠高(P=0.000X^2=83.55),其中横结肠癌中粘液腺癌所占比例高达38.5%(40/104).高分化,中分化,低分化癌中浸润性生长者分别为55.8%(191/342),62.5%(226/361),68.9%(59/86)组间比较有显著性差别(P=0.002 X^2=21.48).结论影响大肠癌淋巴结转移的各因素之间是相互联系、相互影响的.不可能以单一的某种因素作为判断其有无淋巴结转移的指标,临床上需综合分析各种因素所起的作用才能对病情进行合理正确的评估,制定合理的治疗方案.

AIM To find out the relationship between related factors with lymph node metastasis of colorectal cancer,and provide an important basis in diagnosis and treatment of colorectal cancer. METHODS From 1975 to 1999,1374 patients with colorectal carcinoma who had undergone surgery in Nanfang hospital were studied.We analysed all the cases and built up Access database to find out the relationship among the factors,such as circumference of penetration, age,depth of penetration,growth type,differentiated degree,pathological type and tumor site.Discriminant analysis was made with the aid of SPSS9.0/PC+ software. RESULTS On univariate analysis,six variables had a significant association with circumference of penetration. These variables were age (P=0.032,x^2=13.82),depth of penetration (P=0.000,x^2=353.58),growth type (P=0.000,x^2=155.35),differentiated degree (P=0.035, x^2=13.53),pathological type (P=0.000,x^2=31.64),and tumor site (P=0.000,x^2=44.73).In age group of <30, 22.7% (17 of 75) and 14.7% (11 of 75),were mucoid carcinoma and signet-ring cell carcinoma,the rates being greater than other groups (P=0.000,x^2=72.22).The rates of carcinoma spread involving a free serosal surface in mucoid carcinoma and signet-ring cell carcinoma were 81.6% (120 of 147) and 86.36% (19 of 22),being higher than adenocarcinoma 67.7% (574 of 848).The depth of penetration was correlated to differentiated degree (P=0.001,x^2=23.71),growth type and tumor site (P=0.000,x^2=36.96).The rate of mucoid carcinoma was higher in ascending colon,transverse colon,descending colon than that in sigmoid flexure and rectum (P=0.000, x^2=83.55),The rates of invasive growth type in high differentiation,medium differentiation and low differentiation were 55.8% (191 of 342),62.5% (226 of 361) and 68.9% (59 of 86),respectively,and the difference among them was remarkably significant. CONCLUSION The factors related with lymph node metastasis of colorectal cancer are associated and influenced each other.It is impossible to estimate lymph node metastasis by one factor.A comprehensive analysis of all the factors is important in clinical diagnosis and treatment.