pT1-pT2直肠癌患者区域淋巴结转移临床及病理学危险因素分析

目的分析病理分期为pT1．pT2直肠癌患者出现区域淋巴结转移（1ymph node metastasis，LNM）的危险因素。方法对543例直肠癌行直肠癌根治术术后病理分期为pT1．pT2患者资料，用单因素及多因素分析其出现区域LNM的高危因素。结果pT1．pT2患者543例中，76例（14．0％）出现区域LNM，单因素分析提示，肿瘤浸润深度（pT2）、肿瘤形态（非息肉状）、肿瘤低分化（Poor differentiated，PD）、脉管侵犯（Lymphovascular Invasion，LVI）、神经周围侵犯（Perineural Invasion，PNI）（P〈O．01）、瘤床结缔组织形成（中、重度）是术后发现区域LNM的危险因素；Logistic多因素分析提示，LVI、PD、pT2是出现区域LNM的独立危险因素。结论脉管侵犯、肿瘤低分化及肿瘤浸润深度是预测pT1-pT2直肠癌患者出现区域LNM的独立危险因素。

Objectives To analyze the clinicopathologic risk factors associated local lymph node metastasis （ LNM ） in patients with pTl-pT2 rectal cancer. Methods Between October 1995 and October 2012, a total of 543 patients with pT1 or pT2 rectal adenocarcinoma received radical resection at a single institution. Clinicopathologic factors were evaluated by univariate and logistic regression multivariate analyses to identify risk factors for local LNM. Results A total of 543 patients （ 274 men and 269 women ） treated for T1-2 rectal cancers were included in this study. LNM was found in 76 patients （ 14.0% ） . In univariate analysis, lymphovascular invasion （ LVI ） （ P〈0.001 ） , morphology （ polypoid ） （ P=0.033 ） , poor differentiation （ PD ） （ P〈0.001 ） , pefineural invasion （ PNI ） （P〈0.001） , desmoplasia （ moderated and marked ） （ P=0.0035 ） and depth of invasion （ presence ofpT2 ） （ -o〈0.001 ） were significant risk factors. In multivariate analysis, LVI （OR 10.061, 95% CI： 6.178-17.381, -P〈0.001 ） , PD （OR 4.168, 95% CI： 2.377-8.519, P=0.002） , presence ofpT2 （ OR 1.568, 95% CI： 1.013-2.975, P=0.041 ） were significantly related to nodal involvement. Conclusions LVI, PD, and presence of pT2 are independent risk factors predicting LNM in pTl-pT2 rectal carcinoma.