pT1期结直肠癌淋巴结转移危险因素分析

Analysis of risk factors for lymph node metastasis in pT1 colorectal cancer

目的探讨p_(T1)期结直肠癌(CRC)患者淋巴结转移(LNM)的危险因素。方法回顾性选取2017年1月至2023年6月在宁波市医疗中心李惠利医院行一期局部切除+二期补救性根治切除手术或一次性根治切除手术且经术后病理检查证实为p_(T1)期CRC的342例患者为研究对象,其中接受一期局部切除+二期补救性根治切除手术148例。采用多因素logistic回归模型分析p_(T1)期CRC患者和接受一期局部切除+二期补救性根活切除手术的CRC患者LNM的独立影响因素,并构建与验证p_(T1)期CRC患者LNM风险预测模型;比较LNM阳性与阴性患者的5年总体生存率。结果p_(T1)期CRC患者LNM率为13.2%(45/342),肿大淋巴结直径>5 mm(OR=6.751)、组织低分化(OR=4.439)、脉管侵犯(OR=10.395)均是其LNM的独立危险因素(均P<0.05)。接受一期局部切除+二期补救性根治切除手术的CRC患者LNM率为11.5%(17/148),女性(OR=4.274,P=0.023)是其LNM的独立危险因素,深部黏膜下浸润(DSI)不是其LNM的独立危险因素(P=0.067)。LNM阳性与阴性的p_(T1)期CRC患者5年总体生存率比较差异无统计学意义(94.0%比98.0%,P=0.681)。基于肿大淋巴结直径、肿瘤部位、组织分化程度、黏液腺癌、脉管侵犯等5个因素构建的p_(T1)期CRC患者LNM风险预测模型的C指数为0.808,其预测p_(T1)期CRC患者LNM风险的总体正确率为90.6%。结论基于肿大淋巴结直径、肿瘤部位、组织分化程度、黏液腺癌、脉管侵犯等5项因素构建的p_(T1)期CRC患者LNM风险预测模型能为患者后续治疗决策提供一定的帮助,对于接受一期局部切除+二期补救性根治切除手术的患者,应注意DSI可能不是LNM的独立危险因素。

Objective To investigate the risk factors of lymph node metastasis(LNM)in p_(T1)colorectal cancer(CRC).Methods A total of 342 patients who underwent primary local resection+secondary remedial radical resection or one-time radical resection in Ningbo Medical Center Lihuili Hospital from January 2017 to June 2023 and were confirmed as stage p_(T1)CRC by postoperative pathological examination were retrospectively selected as the study objects,among which 148 patients received primary local resection+secondary remedial radical resection.Multivariate logistic regression model was used to analyze the independent influencing factors of LNM in stage p_(T1)CRC patients and CRC patients receiving primary local resection+secondary remedial radical resection,and to construct and verify the LNM risk prediction model for stage p_(T1)CRC patients.The 5-year overall survival rate was compared between LNM-positive and LNM-negative patients.Results The LNM rate in patients with p_(T1)CRC was 13.2%(45/342),enlarged lymph node diameter>5 mm(OR=6.751),histological poor differentiation(OR=4.439)and lymphovascular invasion(OR=10.395)were independent risk factors for LNM in p_(T1)CRC(all P<0.05).The LNM rate of CRC patients who underwent primary local resection+remedial radical resection was 11.5%(17/148),female sex(OR=4.274,P=0.023)was an independent risk factor for LNM,while deep submucosal invasion(DSI)was not independently associated with the risk of LNM(P=0.067).There were no significant differences in overall 5-year survival rate between LNM-positive and LNM-negative patients(94.0%vs.98.0%,P=0.681).Based on five factors(enlarged lymph node diameter,tumor location,tissue differentiation stage,mucinous adenocarcinoma,lymphovascular invasion),a prediction nomogram model for LNM risk in p_(T1)CRC patients was constructed,the C index of the model was 0.808,and its overall correct prediction rate was 90.6%.Conclusion A prediction nomogram model for LNM risk has been developed based on the risk factors(enlarged lymph node diameter,tumor location,tissue differentiation stage,mucinous adenocarcinoma,lymphovascular invasion),which may provide some help in the subsequent treatment of CRC patients undergoing primary local resection.The study also indicates that DSI may not be an independent risk factor for LNM in p_(T1)CRC patients.