直肠癌淋巴结被膜外侵犯与临床病理特征及预后关系的研究

Study on the correlation between extranodal extension of lymph nodes and clinicopathological characteristics as well as prognosis of patients with rectal cancer

目的观察有淋巴结转移的直肠癌患者中淋巴结被膜外侵犯(ENE)状态与临床病理特征及预后的关系。方法回顾性分析2019年1月至2021年12月于四川省人民医院行根治性手术切除的区域淋巴结转移的直肠癌患者132例,收集整理患者临床病理资料及随访信息,病理学评估ENE状态,分析ENE与临床病理特征及预后的相关性。结果132例患者中,发现ENE 63例(47.7%)。与ENE阴性组相比,ENE阳性组神经侵犯更多见,肿瘤出芽级别、T分期和N分期均更高,无病生存(DFS)率更低,差异有统计学意义(P<0.05)。ENE阳性与阴性组间患者性别、年龄、肿瘤部位、肿瘤组织学级别、P53表达模式、Ki-67增殖指数和肿瘤分期比较,差异无统计学意义(P>0.05)。结论直肠癌中ENE阳性状态提示肿瘤更具侵袭性,是一个负向的预后因素,与不良的生存结果相关。

Objective To observe the correlation between extranodal extension(ENE)of lymph nodes and clinicopathological characteristics as well as prognosis of rectal cancer patients.Methods A retrospective study was conducted on 132 rectal cancer patients with regional lymph node metastasis.The patients underwent radical surgery in our hospital between January 2019 and December 2021.Their clinicopathological data and follow-up information were collected.The ENE status was pathologically evaluated.The correlation between ENE and the clinicopathological characteristics as well as prognosis of the patients were analyzed.Results Among the 132 patients,ENE was found in 63 cases(47.7%).Nerve invasion was more frequent and tumor budding grade,T staging,and N staging were higher in the ENE-positive group compared to the ENE-negative group(P<0.05).The disease-free survival(DFS)rate was lower in the ENE-positive group(P<0.05).However,there were no significant differences in gender,age,tumor location,histological grade,expression pattern of P53 protein,proliferation index of Ki-67 protein,and TNM staging between the two groups(P>0.05).Conclusions The ENE positive status in rectal cancer indicates a more aggressive tumor.It is a negative prognostic factor and associated with poor survival outcomes.