中低位直肠癌侧方淋巴结转移的危险因素分析

Analysis of factors associated with lateral lymph node metastasis in mid and low rectal cancer

目的探讨影响中低位直肠癌患者侧方淋巴结转移的相关因素。方法回顾性分析新疆医科大学附属肿瘤医院2004年6月至2010年6月间行根治性切除并侧方淋巴结清扫的203例中低位直肠癌（距肛缘10cm以内）患者的临床资料，采用多因素Logistic回归模型分析侧方淋巴结转移的危险因素。结果203例中低位直肠癌患者共清扫侧方淋巴结3349枚，平均清扫17枚／例，阳性淋巴结数221枚。侧方淋巴结转移度为6．6％（221／3349）。单因素分析显示，年龄、家族史、肿瘤长度、大体类型、组织类型、分化程度、浸润深度、侵犯周径、术前CEA、脉管癌栓、上方淋巴结转移与中低位直肠癌侧方淋巴结转移有关（均P〈0．05）。多因素分析显示，低龄、低分化、浸润型、T4期及存在上方淋巴结转移是中低位直肠癌患者侧方淋巴结转移的独立高危因素（均P〈0．05）。结论对于低龄、低分化、浸润型、T4期及存在上方淋巴结转移等中低位直肠癌患者，由于具有较高的侧方淋巴结转移概率．采用选择性侧方淋巴清扫的手术方案更为合理。

Objective To investigate the factors associated with lateral lymph node metastasis in middle and low rectal cancer. Methods Clinical data of 203 patients with middle and low rectal cancer （within 10 cm from anal verge） undergoing lateral lymph node dissection in the Affiliated Cancer Hospital, Xinjiang Medical University between June 2004 to June 2010, were analyzed retrospectively. Logistic regression analysis was used to screen the associated factom. Results The total number of harvested lateral lymph node was 3349, and average number was 17 per case. The number of positive lateral lymph node was 221, and the lymph node metastasis ratio was 6.6% （221/3349）. Univariate analysis showed that age, family history, tumor length, gross type of tumor, histological type, differentiation, depth of invasion, invasion of circumference, serum CEA, tumor thrombus and upper lymph node metastasis were associated with rectal cancer metastasis （P〈0.05）. Multivariate analysis showed that age, histological type, infiltration depth, gross type, differentiation degree and upper lymph node metastasis were the independent risk factors of the lateral lymph node metastasis in middle and low rectal cancer （P〈0.05）. Conclusion For patients who is young, or with poorly differentiated cancers, infiltrative type, T4 cancer, or those with upper lymph node metastasis, lateral lymph resection may be indicated because of high risk of lateral node metastasis.