M0期结直肠癌淋巴结外肿瘤种植的相关因素分析

Relevant factors of extranodal tumor deposits in M0 colorectal cancer

目的 研究结直肠癌淋巴结外肿瘤种植的影响因素.方法 收集2012年1月至2014年1月249例行结直肠癌根治术病人的临床病理资料,其中男性139例,女性110例,中位年龄55岁（26～81岁）;结肠癌102例,直肠癌147例;隆起型86例,溃疡型93例,浸润型70例.高分化80例,中分化102例,低分化和未分化67例.按美国癌症联合委员会（AJCC）和国际抗癌联盟（UICC）第7版TNM分期;Ⅰ期55例、Ⅱ期65例、Ⅲ期129例.分析其对结直肠癌淋巴结外肿瘤种植的影响.应用SPSS（19.0版）统计软件进行统计学分析,采用卡方检验进行单因素分析,Logistic回归模型进行多因素相关分析,P=0.05为检验水准.结果 入组的结直肠癌淋巴结外肿瘤种植率为17.8％（44/249）;单因素分析结果显示肿瘤分化程度（P=0.001）、浸润深度（P=0.000）、阳性淋巴结数（P=0.000）、脉管浸润（P=0.014）、神经周围浸润（P=0.000）与淋巴结外肿瘤种植密切相关.多因素分析结果显示,与结直肠癌淋巴结外肿瘤种植相关因素的相关程度依次为：神经周围浸润（P=0.001,OR=5.401,95％CI：1.930-15.117）、脉管浸润（P=0.002,OR=3.581,95％CI：1.609-7.968）.结论 结直肠癌的神经周围浸润和脉管浸润是淋巴结外肿瘤种植最主要影响因素.

Objective To investigate the influencing factors of extranodal tumor deposits in coloreetal cancer. Methods The clinicopathological data of patients with colorectal cancer who had un- dergone radical resection from January 2012 to January 2014 were collected and analyzed by the chi- square test and logistic regression analysis using SPSS 19. 0 （P = 0. 05 for inspection level）. Results The rate of extranodal tumor deposits in colorectal cancer was 17. 8% （44/249）. Univariate analysis revealed that differentiation （P = 0. 001）, tumor invasion depth （P = 0. 000）, number of positive lymph nodes （P = 0. 001）, vessel invasion （P = 0. 014）, and perineural invasion （P = 0. 000） were closely correlated with extranodal tumor deposits. The results of logistic regression analysis showed the correlativity of risk factors of extranodal tumor deposits in colorectal cancer was as follows., peri- neural invasion （P = 0. 001, OR = 5. 401, 95%CI： 1. 930-15. 117）, and vessel invasion （P = 0. 002, OR = 3. 581, 95 % CI： 1. 609-7. 968）. Conclusions Perineural invasion and vessel invasion are the key risk factors of extranodal tumor deposits in patients with colorectal cancer.