Ⅱ~Ⅲ期中低位直肠癌术前全程新辅助放化疗后肝转移的危险因素分析

Risk factors of liver metastasis after preoperative total neoadjuvant chemoradiotherapy for middle and low rectal cancer ofⅡ–Ⅲstage

目的探讨Ⅱ~Ⅲ期中低位直肠癌患者术前短程放疗联合化疗后肝转移的危险因素。方法回顾性分析厦门大学附属东南医院2019年1月至2020年6月期间收治的89例Ⅱ~Ⅲ期中低位直肠癌患者的临床资料,所有患者术前均接受短程放疗联合化疗的全程新辅助治疗方案。采用多因素logistic回归分析探索术后肝转移的危险因素。结果89例患者的随访时间为7~53个月,中位随访时间33个月。随访期间内25例患者发生肝转移,发生时间7~35个月,中位肝转移时间为17个月;其中术后第1年发生肝转移患者5例(5.6%),术后第2年发生肝转移15例(16.8%),术后第3年发生肝转移5例(5.6%)。多因素logistic回归分析结果表明,淋巴结转移[OR=3.550,95%CI(1.425,8.953),P=0.041]、脉管侵犯[OR=3.335,95%CI(1.011,11.001),P=0.048]、肿瘤最大长径≥5 cm[OR=4.477,95%CI(1.273,15.743),P=0.019]和肿瘤周径≥1/2[OR=4.633,95%CI(1.387,15.475),P=0.013]者的肝转移发生率较高。结论淋巴结转移、脉管侵犯、肿瘤最大长径≥5 cm、肿瘤周径≥1/2是Ⅱ~Ⅲ期中低位直肠癌患者术前短程放疗联合化疗后肿瘤肝转移的危险因素。

Objective To investigate the risk factors of liver metastasis in patients with middle and low rectal cancer ofⅡ–Ⅲstage after preoperative short course radiotherapy combined with chemotherapy.Methods The clinical data of 89 patients with middle and low rectal cancer ofⅡ–Ⅲstage admitted to the Dongnan Hospital of Xiamen University from January 2019 to June 2020 were retrospectively analyzed.All patients were treated with short-course radiotherapy combined with chemotherapy before operation.The risk factors of postoperative liver metastasis were analyzed by multivariate logistic regression.Results The 89 patients were followed up for 7–53 months,with a median follow-up time of 33 months.During the follow-up period,25 patients developed liver metastasis,the onset time was 7–35 months,and the median time of liver metastasis was 17 months.Among them,5 patients(5.6%)developed liver metastasis in the first year after surgery,15 patients(16.8%)developed liver metastasis at the second year after surgery,5 patients(5.6%)developed liver metastasis at the 3rd year after surgery.Multivariate logistic regression results showed that lymph node metastasis[OR=3.550,95%CI(1.425,8.953),P=0.041],vascular invasion[OR=3.335,95%CI(1.011,11.001),P=0.048],maximum tumor diameter≥5 cm[OR=4.477,95%CI(1.273,15.743),P=0.019],and peri-tumor diameter≥1/2[OR=4.633,95%CI(1.387,15.475),P=0.013]were risk factors for liver metastasis.Conclusions Lymph node metastasis,vascular invasion,maximum tumor diameter≥5 cm,and circumferential tumor diameter≥1/2 are risk factors for liver metastasis in patients with middle and low rectal cancer ofⅡ–Ⅲstage after preoperative short course radiotherapy combined with chemotherapy.