癌结节在结直肠癌患者术后分期中的意义及其对预后的诊断价值:系统评价  

Postoperative staging and diagnostic value of tumor deposits in colorectal cancer patients:a systematic review

作　　者：俞甲子 费正磊[1,2] 周波 杨沔 王达[3,4] 张苏展[3,4] Yu Jiazi;FeiZhenglei ;Zhou Bo;Yang Mian;Wang Da;Zhang Suzhan(Department of Colo-Anorectal Surgery,Ningbo Medical Centre of Lihuili Hospital,Ningbo 315020,China;Department of Colo-Anorectal Surgery,Lihuili Hospital Affiliated to Ningbo University,Ningbo 315020,China;Department of Surgical Oncology,the Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China;Cancer Institute,Key Laboratory of Cancer Prevention and Intervention of China National Ministry of Education,Hangzhou 310009,China)

机构地区：[1]宁波市医疗中心李惠利医院结肠肛肠外科,315020 [2]宁波大学附属李惠利医院结肠肛肠外科,315020 [3]浙江大学医学院附属第二医院肿瘤外科,杭州310009 [4]浙江大学肿瘤研究所暨恶性肿瘤预警与干预教育部重点实验室,杭州310009

出　　处：《中华结直肠疾病电子杂志》2022年第4期288-296,共9页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：浙江省自然科学基金(No.LQ17H160008);浙江省医药卫生科技项目(No.2018KY727)

摘　　要：目的本研究拟通过分析癌结节与结直肠癌预后及转移模式的关系,以期为结直肠癌分期制定提供重要的新依据。方法检索PubMed、Embase、Medline databases、Web of Science、Library、万方、中国知网数据库从建库至2021年期间有关癌结节在结直肠癌预后中的作用相关文献。按纳入和排除标准进行文献筛选,并提取了文献中有关肿瘤分期、组织学特征、及随访结局的数据,并分析癌结节、淋巴结转移(LNMs)和壁外血管侵犯(EMVI)与转移模式及预后的相关性。结果共计18篇文献13383例结直肠癌患者纳入研究,20.3%的患者术后标本提示有癌结节。分析结果显示,癌结节与LNMs(Z=4.79,P<0.01)、EMVI相关(Z=6.19,P<0.01),且与患者更差的预后相关(P<0.05)。配对比较后显示,癌结节对预后的影响强于LNMs和EMVI的影响。癌结节对于不同转移部位的风险比(RR)与LNMs相似;当同时伴有癌结节及LNM时,肝、肺转移的风险明显提高(分别为RR=3.74,95%CI:2.96~4.71;RR=4.38,95%CI:3.29~5.83)。结论结直肠癌患者同时有癌结节存在时,其预后明显较无癌结节的患者预后更差,其中包括N1a、1b的患者。简单地将没有LNMs的癌结节患者定义为N1c,可能导致对患者预后的错误判断。Objective The role of tumor deposits(TDs)in staging remains debated.We have assessed the relation of TDs with metastatic pattern to evaluate whether TDs might add significant new information to staging.Methods A literature review of TDs in the prognosis of CRC using the databases of PubMed,Embase,Medline databases,Web of Science,Library,Wanfang,and China Zhiwang from its establishment to 2021.The literature was screened by inclusion and exclusion criteria,and data on tumor staging,histological features,and follow-up outcomes were extracted from the literature,as well as lymph node metastases(LNMs),extramural vascular invasion(EMVI),and their correlation with metastatic patterns.Results A total of 18 publications involving 13383 colorectal cancer patients were included in the study,and 20.3%presented with TDs.TDs are invariably associated with poor outcome.Presence of TDs was associated with presence of LNMs and EMVI(Z=4.79,P<0.01;Z=6.19,P<0.01,respectively).In a pairwise comparison,effects of TD were stronger than those of both LNMs and EMVI.In terms of risk ratios(RR),TDs and LNMs provided similar results;however,liver and lung metastases were significantly more common when TDs and LNMs were combined(RR=3.74,95%CI:2.96~4.71;RR=4.38,95%CI:3.29~5.83,respectively).Conclusion CRC patients with TD have a significantly worse prognosis than those without TD,including those with N1a and N1b.It is possible to misjudge the prognosis of patients with TDs in the absence of LNMs by simply defining them as N1c.

关 键 词：结直肠肿瘤 癌结节 分期 META分析 

分 类 号：R735.34[医药卫生—肿瘤]