原发性阑尾肿瘤患者术后发生腹膜转移的影响因素及预后分析  

Influencing factors and prognosis of peritoneal metastasis in patients with primary appendiceal neoplasms

作　　者：孙茹梦 姚晓萌 张连峰[1] 周琳[1] SUN Ru-meng;YAO Xiao-meng;ZHANG Lian-feng;ZHOU Lin(Department of Gastroenterology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China)

机构地区：[1]郑州大学第一附属医院消化内科,河南郑州450052

出　　处：《中华实用诊断与治疗杂志》2022年第3期242-246,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：国家自然科学基金(81472325)。

摘　　要：目的分析原发性阑尾肿瘤患者临床资料,探讨其术后发生腹膜转移的影响因素及预后。方法原发性阑尾肿瘤患者176例,均行手术治疗。记录患者性别、年龄、首诊时间、组织病理类型,有无腹膜假性黏液瘤、阑尾穿孔及淋巴结转移,入院时白细胞计数、血红蛋白及血清癌胚抗原(carcinoembryonic antigen, CEA)、糖类抗原(carbohydrate antigen, CA)125、CA19-9水平。术后随访至2021年6月,发生腹膜转移者46例为转移组,未发生腹膜转移者130例为未转移组,比较转移组与未转移组、不同组织病理类型的原发性阑尾肿瘤腹膜转移患者临床病理特征;多因素logistic回归分析原发性阑尾肿瘤患者术后发生腹膜转移的影响因素;Kaplan-Meier法绘制生存曲线,比较转移组与未转移组总生存率。结果转移组首诊时间[1.5(0.6,5.0)个月]长于未转移组[1.0(0.2,3.0)个月](P<0.05),女性(84.8%)、腺癌(69.6%)、有腹膜假性黏液瘤(67.4%)、入院时血红蛋白<110 g/L(30.4%)及血清CEA>5μg/L(67.4%)、CA125>35 u/mL(34.8%)、CA19-9>37 u/mL(34.8%)比率均高于未转移组(58.5%、13.8%、0、10.8%、27.7%、13.8%、9.2%)(P<0.05),年龄[54.5(45.3,65.0)岁]及阑尾穿孔、淋巴结转移、白细胞计数>9.5×10^(5)/L比率(17.4%、4.3%、10.9%)与未转移组[60.0(49.0,67.0)岁、10.8%、3.1%、13.1%]比较差异均无统计学意义(P>0.05)。腺癌(OR=27.391,95%CI:8.169~91.849,P<0.001)、血清CEA>5μg/L(OR=7.392,95%CI:2.209~24.737,P<0.001)、血清CA125>35 u/mL(OR=8.381,95%CI:2.537~27.685,P<0.001)是原发性阑尾肿瘤患者术后发生腹膜转移的危险因素。176例患者随访至2021年6月,失访6例,死亡9例,转移组总生存率[87.8%(36/41)]低于未转移组[96.9%(125/129)](χ^(2)=4.546,P=0.033)。组织病理类型为腺癌的原发性阑尾肿瘤腹膜转移患者腹膜假性黏液瘤比率(78.1%)高于其他组织病理类型者(42.9%)(χ^(2)=4.024,P=0.045),年龄,首诊时间,女性、阑尾穿孔、淋巴结转移比率,白�Objective To analyze the clinical data of patients with primary appendiceal neoplasms,and to investigate the influencing factors of peritoneal metastasis and prognosis.Methods Totally 176patients with primary appendiceal neoplasms underwent surgical treatment.The gender,age,time of first diagnosis,histopathological type,peritoneal mucinous neoplasm,appendiceal perforation and lymph node metastasis were recorded,and the white blood cell count and the levels of hemoglobin,serum carcinoembryonic antigen(CEA),carbohydrate antigen(CA)125and CA19-9levels on admission were detected.The patients were followed up till June,2021,46patients developed peritoneal metastasis(metastasis group)and 130patients developed no peritoneal metastasis(non-metastasis group).The clinicopathological features were compared between metastasis group and non-metastasis group and among patients with different histopathological features of primary appendiceal neoplasms in metastasis group.Multivariate logistic regression analysis was done to analyze the influencing factors of peritoneal metastasis in patients with primary appendiceal neoplasms.Kaplan-Meier method was used to draw a survival curve and compare the overall survival rate between two groups.Results The first diagnosis was later in metastasis group[1.5(0.6,5.0)months]than that in non-metastasis group[1.0(0.2,3.0)months](P<0.05).The percentages of female patients(84.8%),and patients with adenocarcinoma(69.6%),peritoneal mucinous neoplasm (67.4%),hemoglobin<110g/L (30.4%),serum CEA>5μg/L (67.4%),CA125>35 u/mL (34.8%)and CA19-9>37 u/mL (34.8%)in metastasis group were higher than those in non-metastasis group(58.5%,13.8%,0,10.8%,27.7%,13.8%,9.2%)(P<0.05),and there were no significant differences in the age and the percentages of appendiceal perforation,lymph node metastasis,and white blood cell count>9.5×10^(5)/L between metastasis group[54.5(45.3,65.0)years,17.4%,4.3%,10.9%]and non-metastasis group[60.0(49.0,67.0)years,10.8%,3.1%,13.1%](P>0.05).The adenocarcinoma(OR=27.391,95%CI:8.169-

关 键 词：原发性阑尾肿瘤 腹膜假性黏液瘤 腺癌 腹膜转移 预后 

分 类 号：R735.36[医药卫生—肿瘤]