692例直肠癌手术患者临床病理特征对T/N分期的影响

Influence of clinicopathological factors on T/N stage in 692 patients with rectal cancer undergoing surgery

目的 探讨接受根治性手术治疗的直肠癌患者临床病理特征对T/N分期的影响。方法 回顾性分析2015年10月至2019年2月接受手术治疗的692例直肠癌患者的临床病理资料,并分析直肠癌临床病理特征与T/N分期的关系。结果 直肠癌各T分期发生淋巴结转移的概率依次为T_(1)期19.6%、T_(2)期23.6%、T_(3)期56.7%、T_(4)期67.8%。随着T分期增加,淋巴结转移的概率越高,关联系数(Gamma)为0.579(P<0.001)。T_(1)、T_(2)、T_(3)、T_(4)期淋巴结转移的平均数量依次为(0.59±2.22)、(0.62±1.391)、(2.41±3.796)、(3.26±4.719)枚。不同T分期之间在神经侵犯、淋巴脉管癌栓、癌结节、分化程度方面存在显著差异(P<0.05),而在性别、年龄和肿瘤距肛缘距离方面的差异无统计学意义(P>0.05)。性别、肿瘤距肛缘距离与直肠癌淋巴结转移无关(P>0.05),而发病年龄、神经侵犯、淋巴脉管癌栓、癌结节、病理T分期和分化程度与直肠癌淋巴结转移有关(P<0.05)。多因素Logistic回归分析显示,淋巴脉管癌栓、T分期和分化程度是影响直肠癌淋巴结转移的独立因素(P<0.05)。T_(3)和T_(4)期发生淋巴结转移的风险分别为T_(1)期的4.176倍和5.997倍。结论 T分期越高,发生神经侵犯、淋巴脉管癌栓、癌结节的风险更高,分化程度越低。淋巴脉管癌栓、T分期和分化程度是影响直肠癌淋巴结转移的独立因素。

Objective To assess the impact of clinicopathological factors on T/N staginging of rectal cancer patients undergoing radical surgery. Methods The clinicopathological data of 692 rectal cancer patients who received surgery from October2015 to February 2019 were analyzed retrospectively,and the relationship between clinicopathological characteristics and T/N stage was further analyzed. Results The probability of lymph node metastasis in T stage of rectal cancer was 19. 6% in T_(1)stage,23. 6% in T_(2)stage,56. 7% in T_(3)stage and 67. 8% in T_(4)stage. With the increase of T stage,the probability of lymph node metastasis was higher,and the correlation coefficient( Gamma) was 0. 579( P<0. 001). The average number of lymph node metastases in T_(1),T_(2),T_(3)and T_(4)stages was 0. 59 ± 2. 22,0. 62 ± 1. 391,2. 41 ± 3. 796 and 3. 26 ± 4. 719,respectively. There were significant differences between different T stages in terms of nerve invasion,lymphatic vessel tumor thrombus,tumor nodule and degree of differentiation( P<0. 05),but there were no significant differences in terms of gender,age and tumor distance from the anal margin( P>0. 05). Gender,distance from tumor to anal margin were not related to lymph node metastasis of rectal cancer( P>0. 05),but age,nerve invasion,lymphatic vascular tumor thrombus,tumor nodule,pathological T stage and differentiation degree were related to lymph node metastasis of rectal cancer( P<0. 05). Multivariate Logistic regression analysis showed that lymphatic vascular tumor thrombus,T stage and degree of differentiation were independent factors affecting lymph node metastasis( P< 0. 05). The risk of lymph node metastasis in T_(3)and T_(4)stages was 4. 176 times and 5. 997 times higher than that in T_(1)stage,respectively. Conclusion The higher the T stage is,the higher the risk of nerve invasion,vascular tumor thrombus and tumor nodule is,and the lower the degree of tissue differentiation is. Lymphatic vascular tumor thrombus,T stage and degree of differentiation are independent factors affecting lymph node metastasis of rectal cancer.