T1期结直肠癌淋巴结转移及预后危险因素分析

Analysis of lymph node metastasis in T1 stage colorectal cancer and its prognostic risk factors

目的探析T1期结直肠癌患者发生淋巴结转移及其预后的危险因素。方法回顾性分析253例T1期结直肠癌患者的临床资料,患者均接受结直肠癌根治术,以是否出现淋巴结转移分为LNM+组(淋巴结转移阳性,25例)与LNM-组(淋巴结转移阴性,228例)。比较不同黏膜下肿瘤浸润深度患者淋巴结转移、肿瘤组织学类型、脉管瘤栓情况,分析结直肠癌患者发生淋巴结转移的影响因素,分析T1期结直肠癌根治术预后情况及其危险因素。结果253例结直肠癌患者中黏膜下肿瘤浸润深度SM1、SM2、SM3分别是50、68、135例,发生淋巴结转移者分别为0例(0)、6例(8.8%)、19例(14.1%),不同黏膜下肿瘤浸润深度患者的淋巴结转移发生率比较,差异具有统计学意义(P<0.05)。经Logistic回归分析显示,肿瘤组织学类型、黏膜下肿瘤浸润深度是T1期结直肠癌患者发生淋巴结转移的独立危险因素(P<0.05)。LNM+组患者5年无病生存率76.0%、5年总体生存率80.0%低于LNM-组的94.3%、95.2%,差异有统计学意义(P<0.05);不同黏膜下肿瘤浸润深度患者的5年无病生存率和5年总体生存率比较差异均无统计学意义(P>0.05)。Cox单因素分析显示,淋巴结转移、脉管瘤栓、肿瘤组织学类型为T1期结直肠癌患者5年无病生存率的影响因素(P<0.05)。Cox风险回归模型分析显示,肿瘤组织学类型为低分化腺癌或黏液腺癌及存在肿瘤脉管瘤栓是T1期结直肠癌患者5年无病生存率的独立危险因素(P<0.05)。结论肿瘤组织学类型、黏膜下肿瘤浸润深度是T1期结直肠癌患者发生淋巴结转移的独立危险因素,而肿瘤组织学类型为低分化腺癌或黏液腺癌及存在肿瘤脉管瘤栓是T1期结直肠癌患者5年无病生存率的独立危险因素临床应予以重视,建议临床治疗时在局部切除术后加行根治术。

Objective To discuss and analyze the lymph node metastasis in T1 stage colorectal cancer and its prognostic risk factors.Methods The clinical data of 253 patients with T1 stage colorectal cancer were retrospectively analyzed.All patients received radical resection for colorectal cancer and were divided into LNM+group(positive lymph node metastasis,25 cases)and LNM-group(negative lymph node metastasis,228 cases)according to whether there was lymph node metastasis.The lymph node metastasis,tumor histological type,and blood vessel invasion were compared in patients with different submucosal tumor invasion depths.The influencing factors of lymph node metastasis in patients with colorectal cancer,the prognosis and risk factors of T1 stage colorectal cancer after radical resection were analyzed.Results Among the 253 colorectal cancer patients,the submucosal tumor invasion depths of SM1,SM2,and SM3 were 50,68,and 135 cases,with lymph node metastasis occurred in 0 case(0),6 cases(8.8%),and 19 cases(14.1%).The incidence of lymph node metastasis in patients with different depths of submucosal tumor invasion was compared,and the difference was statistically significant(P<0.05).Logistic regression analysis showed that tumor histological type and depth of submucosal tumor invasion were independent risk factors for lymph node metastasis in patients with T1 stage colorectal cancer(P<0.05).The 5-year disease-free survival rates 76.0%and 5-year overall survival rate 80.00%in the LNM+group were lower than 94.3%and 95.2%in the LNM-group,and the difference was statistically significant(P<0.05).The 5-year disease-free survival rates and 5-year overall survival rates of patients with different depth of submucosal tumor invasion were compared,and the difference was not statistically significant(P>0.05).Cox univariate analysis showed that lymph node metastasis,blood vessel invasion,and tumor histology were the influencing factors of 5-year disease-free survival rates in patients with T1 stage colorectal cancer(P<0.05).Cox risk regression model analysis showed that the tumor histological type of poorly differentiated adenocarcinoma or mucinous adenocarcinoma and the presence of blood vessel invasion were independent risk factors for 5-year disease-free survival in patients with T1 stage colorectal cancer(P<0.05).Conclusion Tumor histological type and depth of submucosal tumor invasion are independent risk factors for lymph node metastasis in patients with T1 stage colorectal cancer,while tumor histological type of poorly differentiated hypofractionated adenocarcinoma or mucinous adenocarcinoma and the presence of blood vessel invasion are independent risk factors for 5-year disease-free survival in patients with T1 stage colorectal cancer that should be taken seriously clinically,and suggest adding radical surgery after local resection during clinical treatment.