微卫星状态对结直肠癌根治术(微创)淋巴结检出数量的影响  

The effect of microsatellite status on the number of lymph node retrieved in specimen of radical colorectal cancer surgery

作　　者：张冬生 封益飞 王勇[1] 胥子玮 黄远健 张川 孙跃明 唐俊伟 ZHANG Dong-sheng;FENG Yi-fei;WANG Yong(Department of Rectal Surgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院直肠外科,江苏南京210029

出　　处：《腹腔镜外科杂志》2021年第4期266-271,共6页Journal of Laparoscopic Surgery

基　　金：国家重点研发计划[2017YFC0908200(AH17)]。

摘　　要：目的:探讨微卫星状态对结直肠癌根治术淋巴结检出数量的影响。方法:回顾性收集2015年1月至2019年12月收治的1280例结直肠癌患者的临床资料。采用PCR方法检测肿瘤标本的微卫星状态,分为高度微卫星不稳定性(MSI-H)、低度微卫星不稳定性(MSI-L)与微卫星稳定性(MSS)。观察指标:人口学特征、手术标本病理学检查、微卫星状态。将单因素分析筛选出的潜在影响因素作为自变量(P<0.1),淋巴结检出数量作为因变量进行Poisson回归多因素分析。结果:1280例患者中男800例(62.5%),女480例(37.5%),中位年龄63(26~91)岁,右半结肠癌337例(26.3%),左半结肠癌398例(31.1%),直肠癌545例(42.6%)。腹腔镜手术969例(75.7%),达芬奇手术153例(12.0%),开放手术158例(12.3%)。112例(8.8%)为MSI-H,79例(6.2%)为MSI-L,1089例(85.1%)为MSS。淋巴结检出数量为19(16,23.75)枚,阳性淋巴结检出数为0(0,1)。全组淋巴结转移率为31.56%(404/1280)。MSS/MSI-L患者淋巴结中位检出数19(16,23)枚,MSI-H患者为22(18,30)枚,差异有统计学意义(P<0.05)。MSS/MSI-L、MSI-H患者阳性淋巴结中位检出数分别为0(0,1)枚、0(0,0)枚,差异有统计学意义(P<0.05)。单因素、多因素分析显示,年龄、BMI、肿瘤部位、微卫星不稳定状态、肿瘤最大直径、癌结节是结直肠癌淋巴结检出数量的独立影响因素(P<0.05);术前CEA、术前CA19-9、微卫星不稳定状态、肿瘤分化、病理类型、T分期、癌结节、脉管侵犯、神经侵犯是结直肠癌阳性淋巴结检出数的独立影响因素(P<0.05)。结论:微卫星状态是结直肠癌根治术淋巴结检出数量的独立影响因素,MSI-H患者淋巴结检出数量增多,阳性淋巴结检出数量较少。Objective:To identify the effect of microsatellite status on the number of lymph node retrieved in specimen of radical colorectal cancer surgery.Methods:The clinical data of 1280 patients with colorectal cancer from Jan.2015 to Dec.2019 were retrospectively collected.These patients had received radical resection for colorectal cancer.Microsatellite status was detected by polymerase chain reaction.The patients were divided into microsatellite instability-high(MSI-H),microsatellite instability-low(MSI-L)and microsatellite-stable(MSS)groups.Observation indicators included demography characteristics,postoperative pathological examinations,microsatellite status.Univariate analysis and subsequent multivariable Poisson regression analysis were used to investigate the factors affecting the number of lymph nodes retrieved.Results:Among 1280 colorectal cancer patients,there were 800(62.5%)male and 480(37.5%)female patients.The median age was 63(range 26 to 91 years).There were 337(26.3%)patients with right colon cancer,398(31.1%)with left colon cancer and 545(42.6%)with rectal cancer.There were 969(75.7%)laparoscopic surgeries,153(12.0%)da Vinci surgeries and 158(12.3%)open surgeries.112(8.7%)were MSI-H,79(6.2%)were MSI-L,and 1089(85.1%)were MSS.The median number of lymph node retrieved were 19(16,23.75)and the median number of positive lymph node were 0(0,1).The rate of lymph node metastasis was 31.56%(404/1280).Significant difference was found concerning the number of lymph nodes retrieved in MSS/MSI-L and MSI-H patients[19(16,23)vs.22(18,30),P<0.05].The number of positive lymph nodes were also significantly different between the two groups[0(0,1)vs.0(0,0),P<0.05].Univariate analysis and subsequent multivariable Poisson regression analysis showed that age,BMI,tumor location,microsatellite instability status,maximum diameter and tumor deposits were independent influencing factors of the number of lymph nodes retrieved(P<0.05).The level of preoperative CEA,CA19-9,microsatellite instability status,tumor differentiation degr

关 键 词：结直肠肿瘤 淋巴结检出数量 微卫星状态 腹腔镜检查 

分 类 号：R735.34[医药卫生—肿瘤]