横结肠癌网膜弓淋巴结转移的预后价值  

Prognostic value of gastroepiploic lymph node metastasis in transverse colon cancer

作　　者：王枭杰[1] 黄胜辉[1] 池畔[1] 黄颖[1] 叶道雄 许煜新 Wang Xiaojie;Huang Shenghui;Chi Pan;Huang Ying;Ye Daoxiong;Xu Yuxin(Department of Colorectal Surgery,Fujian Medical University Union Hospital,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院结直肠外科,福州350001

出　　处：《中华消化外科杂志》2021年第3期315-322,共8页Chinese Journal of Digestive Surgery

基　　金：国家临床重点专科建设资助项目[卫办医政函(2012)649号];国家自然科学基金(81902378);福建省卫生计生青年课题(2017-1-39);福建省科技创新联合资金项目(2017Y9104、2017Y9038);福建省自然科学基金卫生联合资金(2016J01456)。

摘　　要：目的探讨横结肠癌网膜弓淋巴结转移的预后价值。方法采用倾向评分匹配及回顾性队列研究方法。收集2010年11月至2017年11月福建医科大学附属协和医院收治的371例横结肠癌病人的临床病理资料;男202例,女169例;中位年龄为58岁,年龄范围为21~92岁。病人均由同一组外科医师施行全结肠系膜切除+网膜弓淋巴结清扫术。371例横结肠癌病人中,15例网膜弓淋巴结转移阳性,356例网膜弓淋巴结转移阴性。观察指标:(1)倾向评分匹配情况及匹配后网膜弓淋巴结转移阴性和阳性横结肠癌病人一般资料比较。(2)网膜弓淋巴结转移阴性和阳性横结肠癌病人随访及生存情况。(3)横结肠癌病人预后影响因素分析。采用电话或门诊方式进行随访,了解病人肿瘤转移及生存情况。术后2年内每3个月随访1次,术后2~5年每6个月随访1次,术后5年每年随访1次。随访时间截至2020年1月。倾向评分匹配按1∶4最近邻匹配法匹配。偏态分布的计量资料以M(范围)表示,组间比较采用秩和检验。计数资料以绝对数表示,组间比较采用χ^(2)检验或Fisher确切概率法。采用Kaplan-Meier法计算生存率并绘制生存曲线,采用Log-rank检验进行生存分析。单因素分析和多因素分析采用COX比例风险回归模型,单因素P<0.10的变量纳入多因素分析。结果(1)倾向评分匹配情况及匹配后网膜弓淋巴结转移阴性和阳性横结肠癌病人一般资料比较:371例横结肠癌病人中,55例(网膜弓淋巴结转移阴性44例、网膜弓淋巴结转移阳性11例)配对成功。倾向评分匹配前网膜弓淋巴结转移阴性病人年龄,M分期(0期、1期),术前癌胚抗原分别为60岁(24~92岁),328例、22例,4.1μg/L(0.2~343.7μg/L),网膜弓淋巴结转移阳性病人上述指标分别为67岁(21~79岁),11例、4例,5.0μg/L(0.7~952.4μg/L),两者上述指标比较,差异均有统计学意义(Z=-1.440,χ^(2)=9.031,Z=-2.086,P<0.05)。经倾向�Objective To investigate the prognostic value of gastroepiploic lymph node(GLN)metastasis in transverse lon cancer.Methods The propensity score matching and retrospective cohort study was conducted.The clinicopathological data of 371 patients with transverse colon cancer who were admitted to Fujian Medical University Union Hospital from November 2010 to November 2017 were collected.There were 202 males and 169 females,aged from 21 to 92 years,with a median age of 58 years.Patients were performed complete mesocolic excision combined with GLN dissection by one group of surgeons.Of the 371 patients with transverse colon cancer,15 cases had positive GLN metastasis(GLN+),and 356 cases had negative GLN metastasis(GLN-).Observation indicators:(1)the propensity score matching conditions and comparison of baseline data between GLN-patients and GLN+patients with transverse colon cancer after propensity score matching;(2)follow-up and survival of GLN-s and GLN+patients with transverse colon cancer;(3)influencing factors for prognosis of patients with transverse colon cancer.Patients were followed up by outpatient examination or telephone interview to detect tumor metastasis and survival.Follow‐up was conducted once every 3 months within postoperative 2 yers,once every 6 months within postoperative 2-5 years and once a year thereafter up to January 2020.The propensity score matching was conducted by 1∶4 matching using the nearest neighbor method.Measurement data with skewed distribution were described as M(range),and comparison between groups was analyzed using the rank sum test.Count data were represented as absolute numbers,and comparison between groups was anlyzed using the chi‐square test or Fisher exact probability.The Kaplan‐Meier method was used to calculate survival rates and draw survival curves,and Log‐rank test was used for survival analysis.Univariate and multivariate analyses were performed using the COX proportional hazard regression model.The variables with P<0.10 in the univariate analysis were incl

关 键 词：结肠肿瘤 横结肠癌 结肠肝曲癌 网膜弓淋巴结 预后 倾向评分匹配 

分 类 号：R735.35[医药卫生—肿瘤]