结直肠癌同时性肝外转移相关临床病理因素分析

Clinical and pathological analysis of simultaneous extrahepatic metastasis of colorectal

目的由于肝脏是结直肠癌最常转移的部位,而肝转移也是结直肠癌(colorectal cancer,CRC)最主要的死亡原因,因此如何预防肝转移的发生成为众多临床医生研究的方向,而对于肝外转移的研究却很少。本研究旨在探讨CRC同时性肝外转移的相关临床病理危险因素。方法通过临床回顾性横断面研究,分析青岛大学附属医院(3 441例)和山东大学附属山东省肿瘤医院(322例)2010-01-01-2015-12-31入院治疗的连续3 763例CRC患者的完整病历资料,通过单因素及多因素非条件Logistic回归分析,对可能影响CRC肝外转移的12个危险因素进行研究。结果 3 763例CRC患者中,发生同时性肝外转移208例,转移率为5.53%。Logistic回归单因素分析显示,癌胚抗原(carcinoembryonic antigen,CEA)、糖类抗原19-9(carbohydrate antigen 19-9,CA19-9)、原发瘤浸润深度(T)、区域淋巴结转移(N)、原发肿瘤部位及肝转移是影响CRC肝外转移的危险因素,均P<0.05。Logistic回归多因素分析显示,CA19-9、原发瘤浸润深度(T)、区域淋巴结转移(N)和肝转移是CRC同时性肝外转移的独立危险因素,均P<0.05。结论 CA19-9、原发瘤浸润深度(T)、区域淋巴结转移(T)和肝转移是影响CRC发生同时性肝外转移的独立危险因素。

OBJECTIVE Since the liver is the site of most metastatic colorectal cancer,and liver metastasis is the most important cause of death of colorectal cancer.Therefore,how to prevent the occurrence of liver metastasis has become the direction of many clinicians.However,there is little research on extrahepatic metastasis.This study was to investigate the clinicopathology risk factors of synchronous extrahepatic metastasis of colorectal cancer（CRC）.METHODS In this cross-sectional retrospective clinical study,the complete clinical record of consecutive 3 763 CRC patients admitted to the Affiliated Hospital of Qingdao University and Shandong Cancer Hospital from January 1,2010 to December 31,2015 were analyzed.Twelve clinicopathological factors that potentially affect the extrahepatic metastasis were analyzed by univariate and following multivariate Logistic regression analysis.The ROC curves of the independent risk factors were used to get the corresponding sensitive values.RESULTS Of 3 763 CRC patients,208 cases had synchronous extrahepatic metastasis with the prevalence of 5.53%.Logistic univariate analysis showed that CEA,CA19-9,depth of invasion,regional lymph node metastasis,tumor location and liver metastasis were the risk factors of extrahepatic metastasis of CRC（all P〈0.05）.Logistic multivariate analysis proved that CA19-9,depth of invasion,regional lymph node metastasis and liver metastasis were independent risk factors for extrahepatic metastasis of CRC（all P〈0.05）.CONCLUSION CA19-9,depth of invasion,regional lymph node metastasis and liver metastasis are independent risk factors for extrahepatic metastasis of CRC.