周围神经侵犯与结直肠癌患者预后的相关性分析  

Analysis on correlation between peripheral nerve invasion with prognosis of patients with colorectal cancer

作　　者：李洪波[1] 袁静静 张佃良[1] 丁慧[2] 林惠忠[1] 杜敏 LI Hong-bo;YUAN Jing-jing;ZHANG Dian-liang;DING Hui;LIN Hui-zhong;DU Min(Department of General Surgery,Qingdao Municipal Hospital,Qingdao 266011,China;Department of Radiology,the Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属青岛市市立医院普外一科,山东青岛266011 [2]青岛大学附属医院放射科,山东青岛266003

出　　处：《中国现代普通外科进展》2022年第6期432-435,共4页Chinese Journal of Current Advances in General Surgery

基　　金：国家自然科学基金面上项目(81270448,81470890)。

摘　　要：目的:探讨周围神经侵犯(PNI)与临床病理特征的关系及其对结直肠癌患者预后的影响。方法:2013年6月至2015年6月,226例结直肠癌患者的临床病理资料,病理检查判断PNI情况,采用χ^(2)检验或Fisher确切概率法分析PNI与临床病理特征的关系;生存分析采用Kaplan-Meier曲线进行描述,组间比较采用log-rank检验;Cox单因素及多因素分析结肠癌预后相关因素。结果:226例结直肠癌患者PNI阳性发生率20.8%(47/226)。PNI阳性率与肿瘤分化程度、T分期、N分期、TNM分期、脉管瘤栓、肿瘤直径、术前CEA水平及MMR状态显著相关(P<0.05)。PNI阳性患者的5年总生存率和5年无病生存率明显低于PNI阴性患者(55.7%vs 75.6%,P<0.01;42.9%vs 65.8%,P<0.01)。多因素分析显示,肿瘤分化程度(HR=2.239,95%CI:1.192~4.063,P=0.019)、N分期(HR=2.536,95%CI:1.530~4.547,P<0.001)、脉管瘤栓(HR=1.883,95%CI:1.092~3.954,P=0.027)、PNI(HR=2.367,95%CI:1.268~4.509,P=0.009)是影响总生存期的独立危险因素。结论:PNI阳性提示结直肠癌患者预后不良,PNI是影响结直肠癌患者预后的独立危险因素。Objective:To investigate the association of peripheral nerve invasion(PNI)with clinico pathological features and its effect on the prognosis of patients with colorectal cancer. Methods: The clinicopathological data of 226 patients with colorectal cancer treated in our hospital from June 2013 to June 2015 were analyzed retrospectively. PNI was judged by HE staining. The relationship between PNI and clinicopathological features was analyzed by χ^(2) test or Fisher’s exact test;survival analysis was described by Kaplan-Meier curve, and log-rank test was used for comparison between groups;Cox univariate and multivariate analysis were used to analyze the prognostic factors of colon cancer. Results: The incidence of PNI in patients with colorectal cancer was 20.8%(47/226).The positive rate of PNI was significantly correlated with the degree of tumor differentiation, T stage, N stage, TNM stage, vascular tumor thrombus, tumor diameter, preoperative CEA level and MMR status(P<0.05). Both 5-year overall survival rate and 5-year disease-free survival rate of PNI positive patients were significantly lower than those of PNI negative patients(55.7% vs 75.6%, P<0.01;42.9% vs 65.8%, P<0.01). Multivariate analysis identified that tumor differentiation(HR=2.239,95%CI: 1.192~4.063, P=0.019), N stage(HR=2.536, 95%CI: 1.530~4.547, P<0.001), vascular tumor thrombus (HR=1.883, 95%CI: 1.092~3.954,P=0.027) and PNI(HR=2.367, 95%CI: 1.268~4.509, P=0.009) were independent risk factors for overall survival. Conclusion: PNI indicates poor prognosis of patients with colorectal cancer, and PNI is an independent risk factor affecting the prognosis of patients with colorectal cancer.

关 键 词：结直肠肿瘤 周围神经侵犯 预后 

分 类 号：R735.35[医药卫生—肿瘤] R735.37[医药卫生—临床医学]