早期结直肠癌与Ⅲ级腺瘤临床、内镜特征的多因素分析

Multivariate Analysis of Clinical and Endoscopic Features of Early Colorectal Cancer and Grade Ⅲ Adenoma

目的探讨早期结直肠癌和结直肠Ⅲ级腺瘤的临床、内镜特征。方法回顾性分析2015年3月~2018年8月177例早期结直肠癌及85例结直肠Ⅲ级腺瘤患者资料,对其临床、内镜特征进行多因素分析。结果症状方面,早期结直肠癌里急后重多[5.1%(9/177)vs.0%(0/85),P=0.034],大便潜血阳性多[49.7%(88/177)vs.29.4%(25/85),χ2=9.653,P=0.002]。内镜特征方面,早期结直肠癌内镜下长径>15 mm多[66.1%(117/177)vs.43.5%(37/85),χ2=12.075,P=0.001],位于直肠多[31.1%(55/177)vs.17.6%(15/85),χ2=5.287,P=0.021],黏膜不光滑(粗糙或绒毛感)多[37.3%(66/177)vs.22.4%(19/85),χ2=5.844,P=0.016],根部白斑多[17.5%(31/177)vs.8.2%(7/85),χ2=3.987,P=0.046]。多因素logistic回归分析显示大便潜血阳性(OR=2.141,95%CI:1.199~3.824,P=0.010),内镜下长径>15 mm(OR=2.025,95%CI:1.147~3.576,P=0.015)是早期结直肠癌的独立影响因素。长径≤15 mm的早期结直肠癌和Ⅲ级腺瘤的临床及内镜特征中,多因素logistic回归分析显示年龄≥55岁(OR=3.228,95%CI:1.076~9.683,P=0.036),贫血(OR=12.368,95%CI:1.396~109.565,P=0.024),位于直肠(OR=3.300,95%CI:1.055~10.329,P=0.040),根部白斑(OR=9.299,95%CI:1.695~51.022,P=0.010)是长径≤15 mm早期结直肠癌的独立影响因素。结论相较于Ⅲ级腺瘤,早期结直肠癌更多出现大便潜血阳性,且病变内镜下长径>15 mm的占比更高。对于较小(长径≤15 mm)的病变,如果患者年龄≥55岁,出现贫血,病变位于直肠或发生根部白斑,则需要警惕早期结直肠癌的可能。

Objective To investigate the clinical and endoscopic features of early colorectal cancer and gradeⅢadenoma.Methods A total of 177 patients with early colorectal cancer and 85 patients with gradeⅢcolorectal adenoma from March 2015 to August 2018 were retrospectively analyzed,and multivariate analysis of clinical and endoscopic features was carried out.Results In terms of symptoms,there were more tenesmus[5.1%(9/177)vs.0%(0/85),P=0.034]and more positive fecal occult blood[49.7%(88/177)vs.29.4%(25/85),χ2=9.653,P=0.002]in early colorectal cancer patients.In terms of endoscopic features,there were more cases with long diameter>15 mm under endoscopy[66.1%(117/177)vs.43.5%(37/85),χ2=12.075,P=0.001],more cases located in the rectum[31.1%(55/177)vs.17.6%(15/85),χ2=5.287,P=0.021],more cases with non-smooth mucous membranes(rough or villous feeling)[37.3%(66/177)vs.22.4%(19/85),χ2=5.844,P=0.016],and more root leukoplakia[17.5%(31/177)vs.8.2%(7/85),χ2=3.987,P=0.046]in early colorectal cancer patients.Multivariate logistic regression analysis showed that positive fecal occult blood(OR=2.141,95%CI:1.199-3.824,P=0.010)and long diameter>15 mm of the lesions(OR=2.025,95%CI:1.147-3.576,P=0.015)were independent influencing factors of early colorectal cancer.For clinical and endoscopic features of early colorectal cancer and gradeⅢadenoma with long diameter≤15 mm,multivariate logistic regression analysis showed that age≥55 years old(OR=3.228,95%CI:1.076-9.683,P=0.036),anemia(OR=12.368,95%CI:1.396-109.565,P=0.024),located in the rectum(OR=3.300,95%CI:1.055-10.329,P=0.040),and root leucoplakia(OR=9.299,95%CI:1.695-51.022,P=0.010)were independent influencing factors of early colorectal cancer.Conclusions Compared with the gradeⅢadenoma,there were more positive fecal occult blood and a higher proportion of lesions with long diameter>15 mm in early colorectal cancer.For small lesions(long diameter≤15 mm),if the patient is more than 55 years old,has anemia,develops lesion located in the rectum,or has root leukoplakia,it is necessary to be alert to the possibility of early colorectal cancer.