结直肠癌肝转移的相关因素

Analysis of Related Factors of Liver Metastasis in Colorectal Cancer

目的分析和探究影响结直肠癌术后患者发生肝转移的临床相关因素。方法采用回顾性分析,收集2016年1月-2019年1月在辽宁中医药大学附属医院肿瘤科住院治疗结直肠癌术后患者病例资料。运用Microsoft Excel软件对结直肠癌患者的性别,年龄,肿瘤位置,分化水平,是否有淋巴结转移,是否化疗,术后理化结果:癌胚抗原(CEA)、甲胎蛋白(AFP)、糖链抗原199(CA19-9),中医四诊资料(主症、次症、舌象、脉象)等信息建立数据库,运用SPSS24.0软件进行K-均值聚类分析、χ2检验。结果(1)根据纳排标准,共有101例患者纳入研究,其中已发生肝转移的有35例,未发生肝转移的有66例。(2)101例结直肠癌术后肝转移的发生与性别,年龄,肿瘤部位,术后AFP无统计学意义(P>0.05),提示无相关性。与分化水平,是否有淋巴结转移,是否化疗,术后CEA、CA19-9,中医证型有统计学意义(P<0.05),提示有相关性。(3)采用K-均值聚类分析得出,结直肠癌术后肝转移各中医证型的分布情况为:肝肾阴虚(40%)>湿热内蕴(28.6%)>脾肾阳虚(20%)>肝脾不和=瘀毒内阻(5.7%);未发生肝转移患者各证型的分布情况为:瘀毒内阻(33.3%)>湿热内蕴(31.8%)>肝肾阴虚(16.7%)>脾肾阳虚(15.1%)>肝脾不和(3%)。结论①结直肠癌术后患者,具备原发肿瘤分化程度低,有淋巴结转移,未行化疗,术后CEA、CA19-9增高条件的患者更容易发生肝转移,这类患者应及早排查和随访,及早诊断和治疗。②结直肠癌术后发生肝转移的患者多为肝肾阴虚证,未发生肝转移患者多为瘀毒内阻证。肝转移患者以虚证居多,未转移者以实证多见。

Objective To analyze and explore the clinical factors affecting liver metastasis in postoperative colorectal cancer patients.Methods Retrospective analysis was performed to collect the data of postoperative colorectal cancer patients hospitalized in the department of oncology,affiliated hospital of Liaoning university of TCM from January 2016 to January 2019.Using Microsoft Excel software for colorectal cancer patients’age,gender,tumor location,differentiation level,whether to have lymph node metastasis,chemotherapy,postoperative physics and chemistry result:carcinoembryonic antigen(CEA)and alpha fetoprotein(AFP),Carbohydrate antigen19-9(CA19-9),four diagnostic data of TCM(primary and secondary symptoms,tongue and pulse condition),such as a database of information SPSS24.0 was used for K-means clustering analysis,χ2 test and Logistic regression analysis.Results(1)According to inclusion and exclusion criteria,a total of 101 patients were included in the study,among which 35 had liver metastasis and 66 did not.(2)There was no statistic difference between the occurrence of liver metastasis in 101 patients with colorectal cancer and gender,age,tumor location,and postoperative AFP(P>0.05),which prompted not relevant.It is related to differentiation level,lymph node metastasis,chemotherapy,postoperative CEA,CA19-9 and syndrome of TCM(P<0.05),which prompted relevant.(3)Concluded from K-means clustering analysis,the TCM syndrome types of postoperative patients with colorectal liver metastasis are:syndrome of liver-kidney yin deficiency(40%)>syndrome of damp-heat accumulation(28.6%)>syndrome of spleen-kidney yang deficiency(20%)>syndrome of liver-spleen disharmony=syndrome of stasis and toxin internal resistance(7%);while the TCM syndrome types of those without liver metastasis are:syndrome of stasis and toxin internal resistance(33.3%)>syndrome of damp-heat accumulation(31.8%)>syndrome of liver-kidney yin deficiency(16.7%)>syndrome of spleen-kidney yang deficiency(15.1%)>syndrome of liver-spleen disharmony(3%)Conclusion①The postoperative patients with colorectal cancer,whose primary tumor has a low degree of differentiation with lymph node metastasis,no chemotherapy and postoperative CEA and CA19-9 increasing,are more likely to have liver metastasis.Such patients should be early screening and followed-up and get early diagnosis and treatment.②Patients with liver metastasis are mostly belong to syndrome of liver-kidney yin deficiency,and those without liver metastasis are mostly belong to syndrome of stasis and toxin internal resistance.There is mostly deficiency syndrome among patients with liver metastasis and excess syndrome among those without liver metastasis.