降结肠、乙状结肠癌及直肠癌第253组淋巴结转移影响因素及预后分析的多中心研究  

Analysis of prognosis and influencing factors of No.253 lymph node metastasis in descending colon,sigmoid colon,and rectal cancer:a multicenter study

作　　者：赵富强 周雷[2] 杜晓辉[3] 武爱文[4] 杨华 徐徕 刘新志 胡时栋[3] 肖毅[5] 刘骞 Zhao Fuqiang;Zhou Lei;Du Xiaohui;Wu Aiwen;Yang Hua;Xu Lai;Liu Xinzhi;Hu Shidong;Xiao Yi;Liu Qian(Department of Colorectal Surgery,National Cancer Center,National Clinical Research Center for Cancer,Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China;Department of Gastrointestinal Surgery,China-Japan Friendship Hospital,Beijing 100029,China;Department of General Surgery,the First Medical Center,Chinese Peoples′Liberation Army General Hospital,Beijing 100853,China;Department of Gastrointestinal Cancer,Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education),Peking University Cancer Hospital and Institute,Beijing 100142,China;Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)

机构地区：[1]国家癌症中心、国家肿瘤临床医学研究中心、中国医学科学院、北京协和医学院肿瘤医院结直肠外科,北京100021 [2]中日友好医院胃肠外科,北京100029 [3]解放军总医院第一医学中心普通外科,北京100853 [4]北京大学肿瘤医院暨北京市肿瘤防治研究所、恶性肿瘤发病机制及转化研究教育部重点实验室胃肠肿瘤中心三病区,北京100142 [5]中国医学科学院、北京协和医学院、北京协和医院基本外科,北京100730

出　　处：《中华外科杂志》2023年第9期760-767,共8页Chinese Journal of Surgery

基　　金：中国医学科学院医学与健康科技创新工程项目(2022-I2M-C&T-B-057)。

摘　　要：目的探讨降结肠、乙状结肠癌及直肠癌第253组淋巴结转移的影响因素,总结第253组淋巴结阳性患者的预后。方法回顾性分析2015年1月至2019年12月在中国医学科学院肿瘤医院、中日友好医院、北京协和医院、解放军总医院第一医学中心和北京大学肿瘤医院完成手术的降结肠癌、乙状结肠癌、直乙交界癌和直肠癌患者的临床资料。根据纳入和排除标准,共纳入3016例患者,男性1848例,女性1168例,年龄≥60岁者1675例,年龄<60岁者1341例。利用中国医学科学院肿瘤医院数据,采用二元Logistic回归模型分析第253组淋巴结转移的影响因素。根据影响因素构建列线图,以其他中心数据作为外部验证集,通过受试者工作特征曲线下面积和校准曲线评价列线图有效性。利用中国医学科学院肿瘤医院数据,将第253组淋巴结阳性组与阴性组进行1∶2倾向性评分匹配,卡钳值为0.05。采用多因素Cox比例风险模型筛选独立预后因素。生存分析采用Kaplan-Meier法和Log-rank检验。结果(1)肿瘤最大径≥5 cm(OR=4.496,95%CI:1.344~15.035,P=0.015)、T分期(T4期比T1期,OR=11.284,95%CI:7.122~15.646,P<0.01)、N分期(N2期比N0期,OR=60.554,95%CI:7.813~469.055,P=0.043)、肿瘤分化程度(中分化比高分化,OR=1.044,95%CI:1.009~1.203,P=0.044;低分化比高分化,OR=1.013,95%CI:1.002~1.081,P=0.013)、肿瘤位置(乙状结肠比降结肠,OR=9.307,95%CI:2.236~38.740,P=0.002)、病理学类型(黏液腺癌比腺癌,OR=79.923,95%CI:15.113~422.654,P<0.01;印戒细胞癌比腺癌,OR=27.309,95%CI:4.191~177.944,P<0.01)、脉管瘤栓阳性(OR=3.490,95%CI:1.033~11.793,P=0.044)是第253组淋巴结转移的独立影响因素。(2)列线图预测模型训练集曲线下面积为0.912(95%CI:0.869~0.955),外部验证集曲线下面积为0.921(95%CI:0.903~0.937)。校准曲线显示模型的预测结果与实际观测结果具有较好的一致性。(3)倾向性评分匹配后,阴性组未达到中位生存期,阳性�Objectives To analyze the influencing factors of No.253 lymph node metastasis in descending colon cancer,sigmoid colon cancer,and rectal cancer,and to investigate the prognosis of No.253 lymph node-positive patients by propensity score matching analysis.Methods A retrospective analysis was performed on clinical data from patients with descending colon cancer,sigmoid colon cancer,rectosigmoid junction cancer,and rectal cancer who underwent surgery between January 2015 and December 2019 from the Cancer Hospital of the Chinese Academy of Medical Sciences,China-Japan Friendship Hospital,Peking Union Medical College Hospital,General Hospital of the Chinese People′s Liberation Army,and Peking University Cancer Hospital.A total of 3016 patients were included according to inclusion and exclusion criteria,comprising 1848 males and 1168 females,with 1675 patients aged≥60 years and 1341 patients aged<60 years.Clinical and pathological factors from single center data were subjected to univariate analysis to determine influencing factors of No.253 lymph node metastasis,using a binary Logistic regression model.Based on the results of the multivariate analysis,a nomogram was constructed.External validation was performed using data from other multicenter sources,evaluating the effectiveness through the area under the receiver operating characteristic curve and the calibration curve.Using data from a single center,the No.253 lymph node-positive group was matched with the negative group in a 1∶2 ratio(caliper value=0.05).Survival analysis was performed using the Kaplan-Meier method and Log-rank test.The Cox proportional hazards model was used to determine independent prognostic factors.Results(1)The tumor diameter≥5 cm(OR=4.496,95%CI:1.344 to 15.035,P=0.015)T stage(T4 vs.T1:OR=11.284,95%CI:7.122 to 15.646,P<0.01),N stage(N2 vs.N0:OR=60.554,95%CI:7.813 to 469.055,P=0.043),tumor differentiation(moderate vs.well differentiated:OR=1.044,95%CI:1.009 to 1.203,P=0.044;poor vs.well differentiated:OR=1.013,95%CI:1.002 to 1.081,P=0.

关 键 词：结直肠肿瘤 结直肠外科手术 第253组淋巴结 多中心研究 列线图 倾向性匹配 

分 类 号：R735.3[医药卫生—肿瘤]