结直肠癌根治术后早期肝转移危险因素及预测价值分析

Risk Factors and Predictive Value of Early Liver Metastasis After Radical Colorectal Cancer Surgery Abstract

目的探讨结直肠癌根治术后早期肝转移的危险因素。方法回顾性分析我院2018年9月至2021年9月收治的261例行结直肠癌根治术患者的相关信息。采用单因素Logistic和多因素Logistic回归分析结直肠癌术后早期发生肝转移的危险因素,采用受试者工作特征(ROC)曲线评估术前CEA水平、脉管侵犯、病理N(pN)分期预测结直肠癌术后早期肝转移的临床应用价值。结果术前CEA水平(HR=2.611,95%CI 1.271~5.379,P=0.009)、脉管侵犯(HR=3.954,95%CI 1.778~8.772,P=0.001)、病理N(pN)分期(HR=7.476,95%CI 3.526~15.844,P<0.001)是结直肠癌根治术后早期肝转移的独立危险因素。ROC曲线显示术前CEA水平、病理N分期联合脉管侵犯ROC曲线下面积为0.831(0.770~0.891),其敏感度和特异度分别为87.3%和66.7%。结论术前CEA水平、脉管侵犯及病理N(pN)分期≥N1是影响结直肠癌根治术后早期肝转移的独立风险因素,可用来预测结直肠癌患者根治术后早期肝转移发生的风险。

Objective To investigate the risk factors of early liver metastasis after radical colorectal cancer resection.Methods A retrospective analysis was performed for the relevant information of 261 patients who underwent radical colorectal cancer surgery in our hospital from September 2018 to September 2021.Univariate Logistic and multivariate Logistic regression were used to analyze the risk factors for early liver metastasis after colorectal cancer surgery,and the receiver operating characteristic(ROC)curve was used to evaluate the clinical application value of preoperative CEA level,vascular invasion and pathological N(pN)stage in predicting early liver metastasis after colorectal cancer.Results Preoperative CEA level(HR=2.611,95%CI 1.271~5.379,P=0.009),vascular invasion(HR=3.954,95%CI 1.778~8.772,P=0.001),and pathological N(pN)stage(HR=7.476,95%CI 3.526~15.844,P<0.001)were independent risk factors for early liver metastasis after radical colorectal cancer resection.The ROC curve showed that the area under the ROC curve was 0.831(0.771~0.891)for preoperative CEA level,pathological N stage combined with vascular invasion,and its sensitivity and specificity were 87.3%and 66.7%,respectively.Conclusion Preoperative CEA level,vascular invasion and pathological N(pN)stage≥N1 are independent risk factors affecting early liver metastasis after radical colorectal cancer resection,which can be used to predict the risk of early liver metastasis after radical resection in colorectal cancer patients.