结直肠癌系膜癌结节相关的病理因素及预后分析

Prognostic analysis and pathological factors of tumor deposits in patients with colorectal cancer

目的探讨结直肠癌病人肠系膜癌结节(tumor deposit,TD)数目对预后的影响。方法回顾性分析2011年3月至2014年11月于武汉大学人民医院胃肠外科行结直肠癌根治术病人的临床病理资料,对病人生存情况进行随访,并对TD有无以及根据TD的截断值(cutoff值)分组的病人进行生存分析。结果TD阳性、T3~4期、N1和N2期、神经侵犯阳性、癌胚抗原(CEA)阳性以及肿瘤病理分化为低分化是结直肠癌病人预后不良的独立危险因素(均P<0.05)。根据TD的cutoff值分组行生存分析,发现TD数目总体上与结直肠癌病人预后呈负相关,且TD数目4~5组病人死亡风险较TD1~3组高[HR=7.596,95%CI(3.147,18.333),P<0.01],TD≥6组病人较TD4~5组病人更高[HR=41.976,95%CI(12.343,142.754),P<0.01]。结论肠系膜TD为结直肠癌病人预后的独立不良因素,且不同TD数目对预后的影响不同,简单将TD阳性(淋巴结转移阴性)划分至N1c期或许不能精确地评估病人预后。

Objective To analyze the clinicopathologic factors associated with the status and number of mesenteric tumordeposit in patients with colorectal cancer,and to explore the effect of the number of tumor depositon the prognosis.Methods The clinicopathologic data of patients who underwent radical surgery for colorectal cancer in the Department of Gastrointestinal Surgery,Renmin Hospital of Wuhan University from March 2011 to November 2014 were retrospectively analyzed.The survival of patients was followed up,and the survival analysis was performed for the presence or absence of tumordeposits and patients grouped according to the cutoff value of tumordeposit.Results Univariate analysis indicated that colorectal cancer patients with tumor deposit,positive CEA,positive nerve invasion,T stage of T3-4,N stage of N1 and N2,poorly differentiated had poor prognosis(all P<0.01).Survival analysis was performed according to the cutoff value of tumor nodule,and found the number of tumor deposit was negatively correlated with the prognosis of patients with colorectal cancer.The risk factor was higher in the group TD4-5 than that in group TD1-3[HR=7.596,95%CI(3.147,18.333),P<0.01],and group TD≥6 were higher than group TD4-5[HR=41.976,95%CI(12.343,142.754),P<0.01].Conclusion Mesenteric tumordeposit are independent adverse factors for the prognosis of patients with colorectal cancer,and the number of different tumordeposit has different effects on the prognosis.It is simple to divide TD positive(negative lymph node metastasis)into N1c stage or cannot accurately evaluate the prognosis of patients.