基于倾向性评分匹配法的纳米碳示踪淋巴结在腹腔镜结直肠癌根治术中的应用效果分析

Clinical application of lymph node labeling with Carbon nanoparticles in laparoscopic radical resection for colorectal cancer on the basis of propensity score matching analysis

目的探讨纳米碳示踪技术在腹腔镜结直肠癌根治术中的临床应用价值。方法回顾性队列研究。纳入2016年1月—2018年12月南京医科大学第一附属医院结直肠外科接受腹腔镜结直肠癌根治术的1343例患者的临床资料,其中男870例、女473例,年龄17~89岁、中位年龄63岁。根据术前是否接受肠镜下纳米碳混悬液病变定位,分为定位组(85例)和非定位组(1258例)。观察指标:(1)两组患者倾向评分匹配情况及匹配后临床资料比较;(2)术中观察定位组病变部位染色情况;(3)比较匹配后两组患者淋巴结检出数及阳性淋巴结数,并进行单因素、多因素分析;(4)观察随访期间患者肿瘤复发转移情况、3年无瘤生存率。结果(1)定位组和非定位组各73例患者匹配成功。匹配后两组患者性别、年龄、体质量指数(BMI)、肿瘤大体病理类型、最大直径、T分期、组织学分级、神经侵犯等基线资料比较,差异均无统计学意义(P值均>0.05)。(2)定位组85例术中均清晰可见肿瘤原发灶部位黑染,均定位准确。(3)定位组淋巴结检出数中位数18(15,24)枚,非定位组为16(14,19)枚,差异有统计学意义(Z=-2.909,P<0.05);两组的阳性淋巴结检出数分别为0(0,1)枚和0(0,0)枚,差异无统计学意义(Z=-1.045,P>0.05)。单因素、多因素分析显示,肿瘤部位、纳米碳定位是结直肠癌术后淋巴结检出数的独立影响因素(P值均<0.05)。(4)146例患者中,142例术后随访3.2~47.0个月,中位随访时间25.0个月。72例定位组患者和70例非定位组患者的3年无瘤生存率分别为83.4%和91.7%,差异无统计学意义(P>0.05)。结论术前肠镜下注射纳米碳可协助腹腔镜手术中准确定位结直肠癌病变所在位置。纳米碳作为淋巴结示踪剂,可以明显增加手术标本的淋巴结检出数目;但其是否能够提高阳性淋巴结检出数、是否能够改善患者的远期生存率,则有待进一步探究。

Objective To investigate the clinical application value of preoperative endoscopic localization with carbon nanoparticle suspension in the treatment of colorectal cancer.Methods A retrospective case-control study was performed.Clinicopathological data of colorectal cancer patients who underwent surgery from January 2016 to December 2018 at the First Affiliated Hospital of Nanjing Medical University were collected.A total of 1343 patients,including 870 males and 473 females,were enrolled in the study.The median age was 63(range:17-89)years old.Patients who received endoscopic localization preoperatively by endoscopic carbon nanoparticle tattooing were allocated into the experimental group.Others with no preoperative endoscopic tattoos were allocated to the control group.Eighty-five patients comprised the experimental group,whereas 1258 patients were in the control group.The observation indicators were as follows:(1)Propensity score matching analysis with patients'general clinicopathological information,including gender,age,body mass index(BMI),and tumor location were compared;(2)The visibility of carbon nanoparticle tattooing in the experimental group was obsered.(3)The number of lymph nodes and positive lymph nodes between the two groups was compared;(4)Follow-up and prognostic analysis were conducted.Results(1)After propensity score matching,73 patients in the experimental group and 73 patients in the control group with comparable characteristics were identified.Variables,such as age,BMI,tumor morphology,tumor size,T stage,tumor differentiation,and perineural invasion,showed no differences between the two groups(all P values>0.05).(2)All colorectal tumor locations in the experimental group were clearly identified with carbon nanoparticle tattooing.(3)The numbers of lymph nodes harvested in the experimental and control groups were 18(15,24)and 16(14,19),respectively,indicating significant differences between the two groups(Z=-2.909,P<0.05).No difference was found concerning the number of positive lymph nodes harvested between the two groups(Z=-1.045,P>0.05).Univariate analysis and subsequent multivariable Poisson regression showed that tumor location and localization with carbon nanoparticles were significantly associated with the number of lymph nodes(all P values<0.05).(4)A total of 142 patients were followed up with a median time of 25.0(range:3.2-47.0)months.The three-year tumor-free survival rate in the experimental group had no significant difference with that of the control group(P>0.05).Conclusions Preoperative endoscopic localization with carbon nanoparticle suspension can assist the identification of tumor location in laparoscopic colorectal cancer surgery.With its lymph node tracing characteristic,carbon nanoparticles can remarkably increase the number of lymph nodes retrieved.Further studies are required to confirm whether carbon nanoparticle suspension can increase the number of positive lymph nodes and improve patients'oncological outcomes.