影响Ⅱ、Ⅲ期结直肠癌术后复发或转移的临床因素分析  

Influence factors on thepostoperative recurrence and metastasis of stage Ⅱ and Ⅲ colorectal cancer

作　　者：王远飚 董坚 李慧[1,2] 马继龙 张琪鹏[1,4] 张锦平 陈艳 WANG Yuanbiao;DONG Jian;LI Hui;MA Jilong;ZHANG Qipeng;ZHANG Jinping;CHEN Yan(Yunnan Province Key Laboratory of Translational Medicine for Cell Therapy Technology/Yunnan Cellular Therapy and Quality Control System Engineering Research Cente,650118 Kunming,China;Yunnan Tumor Research Institute,The Third Affiliated Hospital of Kunming Medical UniversityYunnan Tumor Hospital,650118 Kunming,China;Department of Medical Case Management,The Third Affiliated Hospital of Kunming Medical University Yunnan Tumor Hospital,650118 Kunming,China;Department of Colorectal Surgery,The Third Affiliated Hospital of Kunming Medical UniversityYunnan Tumor Hospital,650118 Kunming,China;Yunnan Cancer Hospital Yunnan Cancer Center,650118 Kunming,China)

机构地区：[1]云南省细胞治疗技术转化医学重点实验室/云南省细胞治疗及质量控制体系工程研究中心,云南昆明650118 [2]昆明医科大学第三附属医院/云南省肿瘤医院肿瘤研究所,云南昆明650118 [3]昆明医科大学第三附属医院/云南省肿瘤医院病案管理科,云南昆明650118 [4]昆明医科大学第三附属医院/云南省肿瘤医院研究结直肠外科,云南昆明650118 [5]云南省癌症中心,云南昆明650118

出　　处：《中国肿瘤外科杂志》2022年第6期545-549,共5页Chinese Journal of Surgical Oncology

基　　金：中央引导地方科技发展资金项目(202107AB110010);云南省细胞治疗技术转化医学重点实验室(2015DG034);云南省韩为东院士专家工作站(202105AF150039)。

摘　　要：目的探讨Ⅱ、Ⅲ期结直肠癌(CRC)患者临床病理特征及其与术后复发或转移的关系。方法纳入2017年12月至2018年12月云南省肿瘤医院结直肠外科收治行根治性手术治疗的CRC患者150例(经术后病理确诊为Ⅱ、Ⅲ期),分析术后出现复发或转移与临床病理特征的相关性。结果150例患者有44例出现复发或转移。分化程度(χ^(2)=9.554,P=0.002)、N分期(χ^(2)=6.724,P=0.035)、CD45+CD3+(χ^(2)=6.194,P=0.045)、CIK细胞比率(χ^(2)=5.624,P=0.018)与Ⅱ、Ⅲ期CRC患者术后出现复发或转移有关。Ⅱ期CRC患者术前外周血CD3+T细胞、CD8+T细胞比率低于Ⅲ期患者(P=0.019,P=0.012)。Cox回归分析显示,N分期、CA19-9是Ⅱ、Ⅲ期CRC患者术后复发或转移的危险因素。结论Ⅱ、Ⅲ期CRC患者的分化程度、N分期、免疫功能与术后复发或转移密切相关,联合监测肿瘤标志物、病理分期与外周血淋巴细胞亚群有助于评估CRC患者免疫状态及术后复发或转移。Objective The aim of this study is to analyze the relationship between clinicopathological features and postoperative recurrence and metastasis in patients withⅡandⅢcolorectal cancer(CRC).Methods The clinical data of 150 patients with stageⅡandⅢCRC who were admitted to the Department of Colorectal Surgery of the Yunnan Tumor Hospital for radical surgical treatment from December 2017 to December 2018 was analyzed retrospectively.The relationships between clinicopathological features and the incidences of recurrence and metastasis were analyzed.Results Recurrence or metastasis occurred in 44 of 150 patients.And univariate analysis showed that the degree of differentiation(χ^(2)=9.554,P=0.002),N stage(χ^(2)=6.724,P=0.035),CD3+T cell(χ^(2)=6.194,P=0.045)and CIK cell ratio(χ^(2)=5.624,P=0.018)were associated with stageⅡandⅢCRC patients with postoperative recurrence or metastasis.The preoperative peripheral blood CD3+T cell and CD8+T cell ratios were lower in stageⅡCRC patients than those in stageⅢpatients(P=0.019,P=0.012).Cox regression analysis showed that N stage and CA19-9 were associated with postoperative recurrence or metastasis in stageⅡandⅢCRC patients.Conclusions The degree of differentiation,N stage,immune function are closely related to postoperative recurrence and metastasis in patients with stageⅡandⅢCRC.Combined monitoring of tumor markers,pathological stage and peripheral blood lymphocyte subsets can be used to evaluate the immune status and postoperative recurrence or metastasis in CRC patients.

关 键 词：结直肠癌 肿瘤复发 转移 肿瘤标志物 淋巴细胞亚群 预后 

分 类 号：R735.34[医药卫生—肿瘤]