2型糖尿病与结直肠癌淋巴结转移关系的病例对照研究

A case-control study of relationship between type 2 diabetes mellitus and lymph node metastasis of colorectal cancer

目的探讨2型糖尿病和结直肠癌患者淋巴结转移的关系。方法收集重庆医科大学附属第一医院2016年1月1日至2017年7月1日符合纳入标准的1 624例结直肠癌患者进行回顾性病例对照研究,分析其中合并2型糖尿病患者(n=208)与未合并糖尿病患者(n=1 416)的淋巴结转移情况。统计学检验水准取α=0. 05,当采用R×C表χ~2检验分割法时,检验水准调整为α’=0. 017。结果淋巴结转移者638例,合并糖尿病组中96例,非糖尿病组中542例,糖尿病组结直肠癌淋巴结转移率高于非糖尿病组(46. 2%vs 38. 3%,P=0. 030)。糖尿病组208例中长期糖尿病患者(糖尿病病程> 2年) 152例,短期糖尿病患者(糖尿病病程≤2年组) 56例,长期糖尿病患者淋巴结转移率高于非糖尿病组(48. 7%vs 38. 3%,P <0. 017)。淋巴结转移率在T3~T4期糖尿病患者(n=157)为56. 1%,在T3~T4期非糖尿病患者(n=1 074)为44. 6%,在T1~T2期糖尿病患者(n=51)为15. 7%,在T1~T2期非糖尿病患者(n=342)为18. 4%;糖尿病T3~T4期淋巴结转移率高于糖尿病T1~T2期(P <0. 017)。结论合并糖尿病、尤其是糖尿病病程大于2年的结直肠癌患者淋巴结转移的风险增高。T分期较高的结直肠癌患者淋巴结转移风险较高,但尚未显示糖尿病对不同T分期患者淋巴转移率有统计学意义的影响,有待进一步研究。

Objective metastasis in patients with colorectal cancer. Methods Affiliated Hospital of Chongqing Medical University from January 2016 to July 2017 were collected for a retrospective casecontrol study,in order to analyze the lymph node metastasis of patients with T2DM( n = 208) and non-T2DM( n = 1 416).The statistical test standard was α = 0. 05. When the partitioning chi-squared test of R × C table was used,the test standard was adjusted to α ’ = 0. 017. Results There were 638 cases of lymph node metastasis,96 cases in the T2DM group and542 cases in the non-T2DM group. The lymph node metastasis rate in the T2DM group was higher than that in the nonT2DM group( 46. 2% vs 38. 3%,P = 0. 030). In the T2DM group( n = 208),there were 152 patients with medium and long-term T2DM( course of T2DM > 2 years),56 patients with short-term T2DM( course of T2DM≤2 years). The lymph node metastasis rate of long-term T2DM patients was higher than that of non-T2DM patients( 48. 7% vs 38. 3%,P <0. 017). The lymph node metastasis rate was 56. 1% in T3-T4 T2DM patients( n = 157),44. 6% in T3-T4 non-T2DM patients( n = 1 074),15. 7% in T1-T2 T2DM patients( n = 51),18. 4% in T1-T2 non-T2DM patients( n = 342). The lymph node metastasis rate was higher in T3-T4 T2DM patients than that in T1-T2 T2DM patients( P < 0. 017).Conclusions The risk of lymph node metastasis is higher in patients with diabetes mellitus,especially in colorectal cancer with a diabetes course of more than 2 years. The risk of lymph node metastasis in colorectal cancer patients with high T stage is higher,but it has not been shown a statistically significant impact of diabete on the lymph node metastasis rate in different T stage patients,which needs further study.