T1、T2结直肠癌系膜转移危险因素及生存分析  

Risk factors of mesentery metastases and survival analysis of T1,T2 colorectal cancer

作　　者：曾杨[1] 何晓生[1] 练磊[1] 吴小剑[1] 马晋平[1] 汪建平[1] 兰平[2] 

机构地区：[1]中山大学附属第六医院结直肠肛门外科 [2]中山大学附属第一医院胃肠胰外科

出　　处：《中华普通外科学文献（电子版）》2013年第3期20-24,共5页Chinese Archives of General Surgery(Electronic Edition)

基　　金：国家自然科学基金项目(81072046)

摘　　要：目的探讨浸润深度T1、T2结直肠癌发生淋巴结/癌结节转移的危险因素及生存情况。方法对260例伴/不伴系膜转移的结直肠癌病例采用Kaplan-Meier法进行生存统计分析,对侵袭前沿组织标本进行免疫组化分析,对各种影响因素行单变量或多变量Cox回归分析。结果共入选260例T1、T2结直肠癌病例,其中无系膜转移者218例,阳性淋巴结和(或)癌结节者42例。出现系膜淋巴结转移或系膜癌结节者,3年无病生存期DFS和5年总体生存期OS均低于阴性组(P<0.01),多因素分析提示女性、组织低分化、神经脉管浸润、术前CEA水平>5μg/L为转移危险因素,CD80在无转移组侵袭前沿表达高于系膜转移组。结论系膜淋巴结转移或癌结节为T1、T2结直肠癌预后不良因素,结直肠癌患者行局部切除须谨慎选择病例,女性、组织低分化、脉管神经浸润、术前CEA增高为发生系膜转移危险因素,CD80在侵袭前沿的高表达为一保护性因素。Objective To investigate the risk factor of local metastases and impact factors of survival for tumor invasion depth as T1,T2 colorectal cancer.Methods Kaplan-Meier model was applied to analyze the long-term survival of 260 colorectal cancer patients.The biomarkers density in tumor invasion frontier were analyzed by immunohistochemistry.Risk factors were studied by COX regression univariated or multivariated analysis.Results Two hundred and sixty cases of T1,T2 colorectal cancer were collected,among them 218 were negative and 42 were positive.The positive group showed poorer result of 3 years disease free survival（DFS） and 5 years overall survival（OS） than the negative group（P〈0.01）.Multivariated analysis indicated the risk factors included female,histology,lymphovascular or perineural invasion,preoperative CEA level 5 μg/L.CD80 expression in negative local metastases appeared higher than positive group.Conclusions Lymph node metastases and/or isolated tumor deposits are negative prognostic factors for T1,T2 colorectal cancer,and the patients should be selected strictly to receive local excision.Female,histology,lymphovascular or perineural invasion,preoperative CEA level 5 μg/L were risk factors of local metastases.CD80 high expression in tumor invasion frontier could be a protective factor.

关 键 词：结直肠癌 淋巴结转移 癌结节 生存分析 危险因素 

分 类 号：R735.3[医药卫生—肿瘤]