结直肠癌根治术后复发转移相关因素的回顾性研究

Retrospective study on factors related to recurrence and metastasis after radical resection of colorectal cancer

目的探讨结直肠癌根治术后复发转移的影响因素。方法收集结直肠癌根治术后复发转移患者的相关资料,以出现复发转移为终点事件,用Kaplan-Meier法对结直肠癌根治术后患者进行生存分析,采用log-rank检验对临床因素[性别、年龄、术前血清癌胚抗原水平、手术方式、原发肿瘤位置、中医证型、化学疗法(以下简称“化疗”)完成情况、口服中药情况]及病理因素(大体形状类型、肿瘤直径、组织学类型、分化程度、脉管和神经侵犯、癌结节、吻合口瘘、淋巴结转移、淋巴转移率、浸润深度、TNM分期、所检淋巴结个数)进行单因素分析,采用Cox回归模型进行多因素分析。结果①共收集417例病例,结直肠癌根治术后复发转移的高峰时间为术后10~12个月,中位无复发生存时间(RFS)为15.3个月。②单因素分析结果显示,组织学类型、分化程度、浸润深度、淋巴结转移、TNM分期、淋巴转移率、脉管和神经侵犯、癌结节、吻合口瘘、中医证型、化疗完成情况、口服中药情况与结直肠癌根治术后RFS相关(P<0.05)。③多因素Cox回归分析结果显示,淋巴结转移[OR=1.724,95%CI(1.353,2.206)]、脉管和神经侵犯[OR=1.661,95%CI(1.116,2.465)]、癌结节[OR=1.801,95%CI(1.083,2.983)]、不同中医证型[OR=1.624,95%CI(1.126,2.473)]、完成全周期化疗[OR=1.738,95%CI(1.163,2.341)]、口服中药[OR=1.791,95%CI(1.328,2.264)]是影响结直肠癌术后RFS的独立危险因素,湿热内蕴证患者复发转移的风险较高,口服中药、完成全周期化疗可以延长患者的RFS。结论结直肠癌根治术后复发转移受淋巴结转移、脉管和神经侵犯、癌结节、化疗完成情况、中医证型、口服中药等因素影响,及早进行中医辨证论治有利于延长结直肠癌根治术后患者的生存期。

Objective To explore the influencing factors of recurrence and metastasis after radical resection of colorectal cancer.Methods Data were collected on patients with recurrence and metastasis after radical resection of colorectal cancer,with the presence of recurrence and metastasis as the endpoint event.The Kaplan-Meier method was used to analyze the survival of patients after radical resection of colorectal cancer.The log-rank test was used perform univariate analysis on clinical factors(gender,age,preoperative serum carcinoembryonic antigen level,surgical method,primary tumor location,traditional Chinese medicine syndrome,completion of chemotherapy,and oral administration of traditional Chinese medicine)and pathological factors(overall shape type,tumor diameter,histological type,degree of differentiation,vascular and neural invasion,cancer nodules,anastomotic fistula,lymph node metastasis,lymphatic metastasis rate,infiltration depth,TNM staging,and number of lymph nodes detected).Cox regression model was used for multivariate analysis.Results①A total of 417 cases were collected,and the peak time for recurrence and metastasis after radical resection of colorectal cancer was 10~12 months after surgery,with a median relapse-free survival time(RFS)of 15.3 months.②The results of univariate analysis showed that histological type,degree of differentiation,depth of infiltration,lymph node metastasis,TNM staging,lymph node metastasis rate,vascular and neural invasion,cancer nodules,anastomotic fistula,traditional Chinese medicine syndromes,completion of chemotherapy,and oral administration of traditional Chinese medicine were correlated with postoperative RFS of colorectal cancer(P<0.05).③The results of multivariate Cox regression analysis showed that lymph node metastasis[OR=1.724,95%CI(1.353,2.206)],vascular and neural invasion[OR=1.661,95%CI(1.116,2.465)],cancer nodules[OR=1.801,95%CI(1.083,2.983)],different traditional Chinese medicine syndromes[OR=1.624,95%CI(1.126,2.473)],completion of full cycle chemotherapy[OR=1.738,95%CI(1.163,2.341)]and oral administration of traditional Chinese medicine[OR=1.791,95%CI(1.328,2.264)]were independent risk factors affecting RFS after colorectal cancer surgery.Patients with internal damp-heat accumulation syndrome had a higher risk of recurrence and metastasis.Oral administration of traditional Chinese medicine and completion of full cycle chemotherapy could prolong the RFS of patients.Conclusions The recurrence and metastasis of colorectal cancer after radical surgery are influenced by factors such as lymph node metastasis,vascular and neural invasion,cancer nodules,completion of chemotherapy,traditional Chinese medicine syndromes,and oral administration of traditional Chinese medicine.Early traditional Chinese medicine syndrome differentiation-based treatment is beneficial to prolong the survival of patients after radical resection of colorectal cancer.