直肠癌患者前腹膜反折高度相关参数的影响因素及临床意义

Analysis of influencing factors and clinical value of anterior peritoneal reflection for patients with rectal cancer

目的基于直肠MRI探讨直肠癌患者一般情况、骨盆形态及肿瘤对前腹膜反折高度的影响,探讨前腹膜反折与MRI侧方淋巴结转移的关系。方法回顾性收集2020年8月至2022年9月北京协和医院基本外科结直肠组直肠癌数据库中432例肿瘤位于前腹膜反折或其下方患者的资料,并纳入98例非直肠癌患者资料作为对照。肿瘤组男性308例,女性124例,年龄[M(IQR)]62(16)岁(范围:24~85岁);对照组男性53例,女性45例,年龄60(22)岁(范围:27~87岁)。使用MRI测量前腹膜反折高度、骨盆及肿瘤参数。建立多因素线性回归模型分析前腹膜反折高度的独立相关因素,并使用倾向性评分匹配法平衡上述因素,比较匹配后两组的前腹膜反折高度。建立有序Logistic回归模型分析前腹膜反折参数与MRI侧方淋巴结转移的关系。结果肿瘤组前腹膜反折高度为(98.7±14.4)mm(范围:43.3~154.0 mm),对照组为(95.1±12.7)mm(范围:68.0~137.9 mm)。多因素线性回归分析结果显示体重越重(B=0.519,95%CI:0.399~0.640,P<0.01)、坐骨棘间径越小(B=-0.172,95%CI:-0.294~-0.049,P=0.006)、前骨盆深度越深(B=0.109,95%CI:0.005~0.213,P=0.039),则前腹膜反折高度越大。倾向性评分匹配后,肿瘤组前腹膜反折高度仍大于对照组[(98.3±14.2)mm比(95.1±12.7)mm,t=-1.992,P=0.047]。有序Logistic回归显示肿瘤侵犯无腹膜段直肠越长是MRI侧方淋巴结转移的独立影响因素(OR=1.016,95%CI:1.002~1.030,P=0.021),而肿瘤下缘至肛缘距离则不是(OR=0.986,95%CI:0.972~1.000,P=0.058)。结论体重越重、骨盆越深越窄,则前腹膜反折位置越高。前腹膜反折与MRI侧方淋巴结转移存在一定联系。

Objectives To investigate the factors influencing the height of anterior peritoneal reflection(APR)for patients with rectal cancer,and to analyze the relationship between the APR and the lateral lymph node metastasis.Methods Clinical data of 432 patients with tumor located within and below APR were retrospectively collected from the rectal cancer database at the Department of General Surgery,Peking Union Medical College Hospital from August 2020 to September 2022.Ninty-eight non-rectal cancer patients were also enrolled as a control group.There were 308 males and 124 females in the tumor group,aged(M(IQR))62(16)years(range:24 to 85 years)and 53 males and 45 females in the control group,aged 60(22)years(range:27 to 87 years).The APR height,pelvis,and tumor-related parameters were measured by MRI.A multifactor linear regression model was established to analyze the dependent correlation factors of APR height.These factors of the two groups were matched by propensity score matching and their APR heights were compared after matching.An ordinal Logistic regression model was established to explore the relationship between APR-related parameters and radiographic lateral lymph node metastasis.Results The APR height of the tumor group was(98.7±14.4)mm(range:43.3 to 154.0 mm)and the control group was(95.1±12.7)mm(range:68.0 to 137.9 mm).Multivariable linear regression revealed that the greater the weight(B=0.519,95%CI:0.399 to 0.640,P<0.01),the anterior pelvic depth(B=0.109,95%CI:0.005 to 0.213,P=0.039)and the smaller the bi-ischial diameter(B=-0.172,95%CI:-0.294 to-0.049,P=0.006),the higher the APR height.The tumor group had a higher APR height than the control group after propensity score matching((98.3±14.2)mm vs.(95.1±12.7)mm,t=-1.992,P=0.047).Ordinal Logistic regression indicated that the longer segment of the tumor invade the nonperitoneal rectum was an independent influencing factor of radiographic lateral lymph node metastasis(OR=1.016,95%CI:1.002 to 1.030,P=0.021),while the distance between the anal verge and the tumor was not(OR=0.986,95%CI:0.972 to 1.000,P=0.058).Conclusions The higher the weight,the deeper and narrower the pelvis,the higher the APR height.There is a certain relationship between APR and lateral lymph node metastasis on imaging.