散发性年轻结直肠癌远处转移的危险因素及预后因素分析  

Risk factors of distant metastasis in young patients with sporadic colorectal cancer

作　　者：李琪 俞明明[3] 邵巧晔 崔巍[1] LI Qi;YU Mingming;SHAO Qiaoye;CUI Wei(Department of Colorectal Surgery,Ningbo Medical Treatment Center Lihuili Hospital,Ningbo 315041,China)

机构地区：[1]宁波市医疗中心李惠利医院肛肠外科,315041 [2]宁波市医疗中心李惠利医院病案统计室,315041 [3]宁波大学附属人民医院放射科

出　　处：《浙江医学》2021年第22期2411-2414,2440,共5页Zhejiang Medical Journal

摘　　要：目的探讨散发性年轻结直肠癌远处转移的危险因素及预后因素。方法回顾性分析宁波市医疗中心李惠利医院2010至2019年收治的127例散发性年轻结直肠癌患者的临床病理资料,确诊时存在远处转移30例。总结远处转移特点,分析远处转移的危险因素及预后因素。结果远处转移部位以肝脏(46.7%)、腹膜(46.7%)多见。单因素分析显示,肿瘤分化程度、浸润深度、淋巴结转移、癌胚抗原(CEA)、糖类抗原19-9(CA19-9)与散发性年轻结直肠癌远处转移有关(均P<0.05);二元logistic回归分析显示,淋巴结转移(OR=3.572,95%CI:1.041~12.250,P<0.05)是散发性年轻结直肠癌远处转移的独立危险因素;血清CEA、CA19-9水平预测散发性年轻结直肠癌远处转移的AUC、截断值、灵敏度、特异度分别为0.757、6.15μg/L、0.759、0.807和0.710、33.35 U/ml、0.621、0.830。30例发生远处转移的患者最终完成随访21例,其中死亡13例,存活8例;总生存期22(12,28)个月,2年生存率为28.6%。单因素分析显示,不同肿瘤分化程度、治疗方式的散发性转移性年轻结直肠癌患者总生存期比较,差异均有统计学意义(均P<0.05)。结论散发性年轻结直肠癌远处转移部位以肝脏、腹膜多见;淋巴结状态是影响其发生远处转移的独立危险因素,血清CEA、CA19-9水平对远处转移具有一定的预测效能;肿瘤分化程度、治疗方式可能影响远处转移患者的预后。Objective To explore the risk factors of distant metastasis of young patients with sporadic colorectal cancer.Methods The clinical data of 127 patients with sporadic colorectal cancer admitted in Lihuili Hospital during 2010 to 2019 were analyzed.The distant metastasis occurred in 30 cases,the risk factors of metastasis and prognostic factors of patients were analyzed.Results Among metastatic patients,46.7%had peritoneal metastasis,and 46.7%had liver metastasis.Univariate analysis showed that tumor differentiation,depth of bowel wall invasion,lymph node status,serum CEA level and serum CA19-9 level were significantly correlated with metastasis(all P<0.05).Multivariate analysis indicated that lymph node status was an independent risk factor for metastasis(OR=3.572,95%CI:1.041-12.250,P<0.05).The area under the ROC curve for CEA and CA19-9 to predict metastasis was 0.757 and 0.710(all P<0.05),respectively.When the cut-off value of CEA was 6.15μg/L,the sensitivity and specificity were 0.759 and 0.807,respectively.When the cut-off value of CA19-9 was 33.35 U/ml,the corresponding sensitivity and specificity were 0.621 and 0.830,respectively.Twenty one patients were followed up,the median survival time was 22 months,and the 2-year overall survival rate was 28.6%.The results of univariate analysis showed tumor differentiation and the treatment method were related prognostic factors of young patients with metastatic colorectal cancer(all P<0.05).Conclusion Young patients with sporadic colorectal cancer have unique metastatic characteristics.Lymph node status is an independent risk factor of metastasis.Serum CEA and CA19-9 have a certain predictive value for distant metastasis.Tumor differentiation and treatment method may be related factors for the prognosis of patients.

关 键 词：散发性 年轻 结直肠癌 远处转移 危险因素 预后因素 

分 类 号：R735.34[医药卫生—肿瘤]