结直肠癌根治术后5年内骨转移的危险因素分析

Analysis of risk factors for bone metastasis after radical resection of colorectal cancer within 5 years

目的 探讨结直肠癌根治术后5年内骨转移的危险因素。方法 回顾性分析2001年1月至2010年12月间第二军医大学附属长海医院肛肠外科收治的1 749例结直肠癌患者的临床资料，其中50例（2.8%）术后出现骨转移。分别采用χ2检验和Logistic多因素分析模型，对性别、年龄、肿瘤位置、术前血清癌胚抗原水平、肿瘤组织学类型、肿瘤浸润深度、淋巴结转移、是否伴肺转移和伴肝转移等可能影响术后骨转移的临床病理特征，进行单因素和多因素分析。结果 50例出现骨转移的患者中，男29例，女21例；≥60岁者28例。肿瘤位于直肠36例，结肠14例；腺癌43例，黏液腺癌7例；42例患者的肿瘤浸润深度为T3~ 4期，30例有淋巴结转移，14例伴肺转移，5例伴肝转移。单因素分析显示，肿瘤位置（χ2= 4.932，P= 0.026）、术前血清CA199水平（χ2= 4.266，P= 0.039）、淋巴结转移（χ2= 13.054，P= 0.000）和伴有肺转移（χ2= 35.524，P= 0.000）是影响结直肠癌根治术后5年内骨转移的相关因素。直肠癌的术后5年骨转移率为3.6% （36/991），明显高于结肠癌1.8%（14/758）；术前血清CA199水平≥37 kU/L结直肠癌者发生骨转移率为4.9%（12/245），明显高于CA199水平〈37 kU/L者的2.5%（38/1 504）；有淋巴结转移和伴肺转移的患者发生术后5年骨转移率分别为4.8% （30/627）和11.6% （14/121），明显高于无淋巴结转移1.8%（20/1 122）和无肺转移2.2%（36/1 628）的结直肠癌患者。Logistic多因素分析显示，肿瘤位于直肠（OR：0.508，95%CI：0.268~ 0.963，P= 0.038）、淋巴结转移（OR ：2.291 ，95%CI：1.273~ 4.122，P= 0.006）以及伴有肺转移（OR ：4.796，95%CI：2.473~ 9.301，P= 0.000）是影响结直肠癌根治术后5年内发生骨转移的独立危险因素。结论 肿瘤位于直肠、有淋巴结转移以及伴有肺转移的结直肠癌患者术后5年内更容易发生骨转移。

Objective To investigate the risk factors of metachronous bone metastasis after radical resection of colorectal cancer within 5 years.Methods Clinical data of 1 749 patients with colorectal cancer, of whom 50 （2.8% ） patients developed metastasis to bone after operation, in the Department of Colorectal Surgery, Changhai Hospital of The Second Military Medical University from January 2001 to December 2010 were analyzed retrospectively. Univariate and multivariate analysis were performed to find the risk factors of metachronous bone metastasis from colorectal cancer using Chi square test and Logistic regression, respectively.Results Of 50 colorectal cancer cases with bone metastasis, 29 were male and 21 were female. The age was ≥ 60 years old in 28 cases. Tumors of 36 cases were located in the rectum and of 14 cases located in the colon. Pathology examination showed 43 cases were adenocarcinomas, 7 cases were mucinous adenocarcinoma. Forty-two cases had T3-4 stage lesions, 30 cases had lymph node metastasis, 14 cases had pulmonary metastasis, and 5 cases had liver metastasis. Univariate Chi square test indicated that factors associated with the metachronous bone metastasis of colorectal cancer within 5 years were tumor site （χ2 = 4.932, P = 0.026） , preoperative carbohydrate antigen 199 （CA199） level （χ2 = 4.266, P = 0.039） , lymph node metastasis （χ2 = 13.054, P = 0.000） and pulmonary metastasis （χ2 = 35.524, P = 0.000）. The incidence of bone metastasis in patients with rectal cancer （3.6%, 36/991） was higher compared to those with colon cancer （1.8%, 14/758）. The incidence of bone metastasis in patients with higher（〉 37 kU/L） preoperative serum CA199 level （4.9% , 12/245） was higher compared to those with lower serum CA199 level （2.5% , 38/1504）. The incidence of bone metastasis in patients with lymph node metastasis （4.8%, 30/627） and pulmonary metastasis （11.6% , 14/121） was significantly higher compared to those without lymph node metastasis （1.8%, 20/1122） and pulmonary metastasis （2.2%, 36/1628） , respectively. Logistic multivariate analysis showed that rectal cancer （OR： 0.508, 95%CI：0.268 to 0.963, P= 0.038） , lymph node metastasis （OR： 2.291, 95%CI： 1.273 to 4.122, P= 0.006） and metachronous pulmonary metastasis （OR： 4.796, 95%CI： 2.473 to 9.301, P = 0.000） were the independent risk factors of metachronous bone metastasis of colorectal cancer within 5 years.Conclusion Patients with rectal cancer, lymph node metastasis and metachronous pulmonary metastasis are high risk groups of metachronous bone metastasis after radical resection of colorectal cancer within 5 years.