老年结直肠癌肺转移的CT诊断及易发因素研究

CT features and influencing factors of lung metastasisin elderly patients with colorectal cancer

[目的]分析老年结直肠癌肺转移的CT诊断及易发因素,以期为临床诊治提供参考。[方法]入选接受了胸腹部CT增强扫描、年龄为65~84岁的结直肠癌患者420例,按照是否出现肺转移划分为肺转移组、对照组。纳入患者的各项资料,包括性别、年龄、体质指数(BMI)、吸烟时间、原发肿瘤部位以及大小、原发灶病理类型、Dukes分期、脉管浸润、癌胚抗原(CEA)等。利用单因素分析找出影响癌症转移的因素,并利用多因素Logistic回归分析找出影响老年结直肠癌肺转移的主要因素。[结果]420例中同时并肺转移者96例(肺转移组),发生率为22.86%;非肺转移者324例(对照组)。肺转移CT征象一般是直径≤3 cm的多发病灶,基本上都是实性结节,内部体现出了均匀性。通过单因素分析得出,2组原发肿瘤部位、Dukes分期、原发灶病理类型和CEA水平比较均差异有统计学意义(P<0.05)。通过多因素Logistic回归分析得出,直肠癌(OR=3.028,95%CI:1.865~4.514,P<0.05)、Dukes C期(OR=2.836,95%CI:1.721~3.894,P<0.05)、腺癌(OR=2.451,95%CI:1.382~3.653,P<0.05)、CEA(OR=2.746,95%CI:1.693~3.821,P<0.05)是结直肠癌肺转移的危险因素。[结论]老年结直肠癌肺转移CT病灶,形态和大小等不相同,导致癌症转移的主要因素有直肠癌、Dukes分期C期、腺癌、ECA水平升高,临床上应重视上述因素带来的影响力,并关注患者各项指标变化情况。

[Objective]To analyze CT diagnosis and predisposing factors of lung metastasisin elderly colorectal cancer.[Methods]A total of 420 elderly patients with colorectal cancer who received diagnosis and treatment in our hospital from September 2016 to September 2020 were divided into two groups according to the presence of lung metastasis, which were lung metastasis group and control group.Every patient underwent chest and abdominal CT enhancement scans.Patients’ data were recorded, including gender, age, length of body mass index(BMI)smoking, location and size of primary tumor, pathologic type of primary tumor, Dukes stage, vascular infiltration, and carcinoembryonic antigen(CEA).Univariate analysis was used to identify the factors affecting cancer metastasis, and multivariate Logistic regression analysis was used to identify the main factors affecting lung metastasis of colorectal cancer in the elderly.[Results]A total of 96 elderly colorectal cancer patients with pulmonary metastasis, the incidence rate reached 22.86%.CT findings of lung metastases were generally multiple lesions less than 3 cm in diameter, which were basically solid nodules with internal uniformity.Univariate analysis showed that there were statistically significant differences in the site of primary tumor, Dukes stage, pathological type of primary tumor and CEA level between the two groups(P<0.05).Multivariate Logistic regression analysis showed that colorectal cancer(OR=3.028,95%CI:1.865-4.514,P<0.05),Dukes C stage(OR=2.836,95%CI:1.721-3.894,P<0.05),adenoma(OR=2.451,95%CI:1.382-3.653,P<0.05),CEA(OR=2.746,95%CI:1.693-3.821,P<0.05)were risk factors leading to the occurrence of disease.[Conclusion]There are differences in CT scans of lung metastases in elderly patients with colorectal cancer, as well as differences in shape and size.There are many main factors leading to cancer metastasis, including rectal cancer, Dukes stage C,adenocarcinoma and elevated ECA level.Clinically, attention should be paid to the influence of the above factors and the changes of various indicators in patients.