早期结直肠癌经内镜非治愈性切除术后癌残留或淋巴结转移的风险因素分析

Risk factors for residual cancer or lymph node metastasis after endoscopic noncurable resection of early colorectal cancer

目的:探讨早期结直肠癌经内镜非治愈性切除术后癌残留或淋巴结转移的相关风险因素,预测癌残留或淋巴结转移的风险。方法:收集2009—2019年于中国医学科学院肿瘤医院因早期结直肠癌行内镜下治疗且内镜切除术后病理提示为非治愈性切除并追加外科根治手术的81例患者的临床病理资料,分析各临床病理特征与内镜切除术后癌残留或淋巴结转移风险的关系,影响因素分析采用logistic多因素回归分析。结果:全组81例患者中,外科根治术后病理提示癌残留或淋巴结转移阳性17例(21.0%),阴性64例(79.0%)。17例癌残留或淋巴结转移阳性的患者中,3例仅有癌残留(其中2例垂直切缘阳性),11例仅有淋巴结转移,3例同时有癌残留及淋巴结转移。病变位置、低分化癌、黏膜下层浸润深度≥2 000 μm、静脉侵犯与内镜非治愈性切除术后发生癌残留或淋巴结转移有关(均 P<0.05)。logistic多因素回归分析显示,低分化癌( OR=5.513,95% CI:1.423~21.352, P=0.013)是早期结直肠癌经内镜非治愈性切除术后癌残留或淋巴结转移的独立危险因素。 结论:对于经内镜非治愈性切除术后的早期结直肠癌,术后黏膜病理合并有低分化癌、黏膜下层浸润深度≥2 000 μm、静脉侵犯以及病变位于降结肠、横结肠、升结肠及盲肠时,与癌残留或淋巴结转移相关,低分化癌是早期结直肠癌经内镜非治愈性切除术后发生癌残留或淋巴结转移的独立危险因素,建议经内镜治疗后追加外科根治手术。

Objective Risk factors related to residual cancer or lymph node metastasis after endoscopic non-curative resection of early colorectal cancer were analyzed to predict the risk of residual cancer or lymph node metastasis,optimize the indications of radical surgical surgery,and avoid excessive additional surgical operations.Methods Clinical data of 81 patients who received endoscopic treatment for early colorectal cancer in the Department of Endoscopy,Cancer Hospital,Chinese Academy of Medical Sciences from 2009 to 2019 and received additional radical surgical surgery after endoscopic resection with pathological indication of non-curative resection were collected to analyze the relationship between various factors and the risk of residual cancer or lymph node metastasis after endoscopic resection.Results Of the 81 patients,17(21.0%)were positive for residual cancer or lymph node metastasis,while 64(79.0%)were negative.Among 17 patients with residual cancer or positive lymph node metastasis,3 patients had only residual cancer(2 patients with positive vertical cutting edge).11 patients had only lymph node metastasis,and 3 patients had both residual cancer and lymph node metastasis.Lesion location,poorly differentiated cancer,depth of submucosal invasion≥2000μm,venous invasion were associated with residual cancer or lymph node metastasis after endoscopic(P<0.05).Logistic multivariate regression analysis showed that poorly differentiated cancer(OR=5.513,95%CI:1.423,21.352,P=0.013)was an independent risk factor for residual cancer or lymph node metastasis after endoscopic non-curative resection of early colorectal cancer.Conclusions For early colorectal cancer after endoscopic non-curable resection,residual cancer or lymph node metastasis is associated with poorly differentiated cancer,depth of submucosal invasion≥2000μm,venous invasion and the lesions are located in the descending colon,transverse colon,ascending colon and cecum with the postoperative mucosal pathology result.For early colorectal cancer,poorly differentiated cancer is an independent risk factor for residual cancer or lymph node metastasis after endoscopic non-curative resection,which is suggested that radical surgery should be added after endoscopic treatment.