T1和T2期直肠癌淋巴结转移规律及其影响因素研究

Rule of Lymph Node Metastasis in T1 to T2 Staging Invasive Rectal Carcinoma and Its Influencing Factors

目的阐述T1和T2期直肠癌淋巴结转移规律及其影响因素,探讨直肠癌局部切除适应证。方法选择2002年1月—2012年12月浙江省立同德医院和浙江省海盐县中医院收治的并接受根治性手术的原发性T1和T2期直肠癌患者116例,回顾性分析其临床病理资料。结果本组116例直肠癌患者发生淋巴结转移24例,总淋巴结转移率为20.7%,T1、T2期患者淋巴结转移率分别为3.9%(2/51)、33.8%(22/65),T1期患者淋巴结转移率低于T2期患者(χ2=15.595,P<0.001)。单因素分析结果显示,肿瘤大体类型(χ2=6.839,P=0.033)、组织类型(χ2=7.756,P=0.005)、分化程度(χ2=46.039,P<0.001)和T分期(χ2=15.595,P<0.001)与淋巴结转移有关。二分类多元Logistic回归分析发现,肿瘤分化程度(OR=3.374)及T分期(OR=6.727)对回归方程的影响有统计学意义(P<0.05)。结论肿瘤分化程度和浸润深度是T1、T2期直肠癌发生淋巴结转移的最主要影响因素,对分化程度较高的T1期直肠癌可考虑局部切除。

Objective To discuss the rule of lymph node metastasis in T1 to T2 staging invasive rectal carcinoma and its influencing factor as well as the indication for local excision of rectal cancer.Methods 116 cases of T1 to T2 staging invasive rectal carcinoma were selected who were admitted to Tongde Hospital of Zhejiang Province and Haiyan County TCM Hospital and received surgical resection from January 2002 to December 2012.The clinical data of the cases were analyzed retrospectively.Results The rate of lymph node metastasis in T1 to T2 staging invasive rectal carcinoma was 20.7%（24 /116）,and that rate in T1 and in T2 was 3.9%（2 /51） and 33.8%（22 /65）,respectively,indicating higher rate in T1 than in T2（χ2= 15.595,P〈0.001）.Univariate analysis showed that the massive type of the tumor（χ^2= 6.839,P = 0.033）,histology type（χ^2= 7.756,P = 0.005）,differentiating degree of the tumor（χ2= 46.039,P〈0.001） and tumor T staging（χ^2= 15.595,P〈0.001） were influencing factors for lymph node metastasis.Multivariate Logistic regression analysis showed that the differentiating degree of the tumor（OR = 3.374） and tumor T staging（OR = 6.727） had statistically significant influence over the regression equation（P〈0.05）.Conclusion The differentiating degree of the tumor and the depth of tumor invasion were the most influencing factors for lymph node metastasis in T1 to T2 staging rectal carcinoma.T1 staging rectal carcinoma with higher degree of differentiation could be considered local excision.