女性结直肠癌合并卵巢转移患者的临床特征和预后分析  

Characteristics and prognosis analysis of female patients with colorectal cancer complicated with ovarian metastasis

作　　者：王敏仪[1] 陈淑琴 赖慧玲 李骁[1] 陈晓川 金庄 李锦波 Wang Minyi;Chen Shuqin;Lai Huilin;Li Xiao;Chen Xiaochuan;Jin Zhuang;Li Jinbo(Department of Gynecology,the Sixth Affiliated Hospital,Sun Yat-sen University/Biomedical Innovation Center,the Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,China)

机构地区：[1]中山大学附属第六医院妇科/广州市黄埔区中六生物医学创新研究院,广州510655

出　　处：《中华转移性肿瘤杂志》2023年第4期380-384,共5页Chinese Journal of Metastatic Cancer

基　　金：广东省基础与应用研究项目(2021A1515011791);广东省基础与应用研究项目(2022A1515012401);中山六院临床医学研究1010计划(1010CG(2022)-13)。

摘　　要：目的探讨结直肠癌合并卵巢转移患者的临床特点及预后影响因素。方法回顾性分析2010年1月至2022年9月因"结直肠癌可疑卵巢转移"在我院行手术治疗的177例患者资料,根据病理确诊有无卵巢转移分为转移组(132例)和无转移组(45例)。Kaplan-Meier法生存分析,Log-rank法检验和单因素预后分析,Cox模型多因素预后分析。结果与无转移组相比,转移组平均年龄明显年轻[(47.64±13.58)岁∶(52.33±13.08)岁,t=2.023,P=0.045],术前平均糖类抗原125水平明显升高(29.90 U/mL∶13.10 U/mL,t=-4.300,P<0.001),新辅助化疗和影像学阳性的比例明显增加(55.3%∶33%,χ^(2)=6.479,P=0.011和79.5%∶7%,χ^(2)=4.936,P=0.011)。转移组中还可见中分化腺癌发生卵巢转移的比例最高(60.6%),其次为黏液腺癌/印戒细胞癌(23.5%)、高分化腺癌(9.1%)、低分化腺癌(6.8%);肿瘤原发部位位于降结肠/乙状结肠的比例最高(40.2%),其次为直肠(24.2%)、升结肠(23.5%)、横结肠(12.1%)。与无转移组相比,转移组的腹膜转移比例明显降低(31.8%∶62%,χ^(2)=12.976,P<0.001)。转移组与无转移组60个月生存率相近(30%∶45%,P=0.851)。单因素分析显示年龄(OR=1.027)、影像学阳性(OR=54.44)、血清糖类抗原125水平(OR=0.992)、新辅助化疗(OR=2.475)、肿瘤位于降乙结肠/直肠(OR=3.633/3.509)、腹膜转移(OR=0.283)是影响预后的因素(均P<0.05)。多因素分析显示仅腹膜转移影响患者预后(HR=2.077,P=0.009)。结论女性结直肠癌患者腹膜转移是影响预后的重要因素。当为中分化腺癌、黏液腺癌/印戒细胞癌,肿瘤位于降结肠/乙状结肠、直肠,影像学阳性且围绝经期情况下,在充分知情告知下可考虑行预防性输卵管卵巢切除术。Objective To investigate the clinical characteristics and prognostic factors of patients with colorectal cancer complicated with ovarian metastasis.Methods From January 2010 to September 2022,a total of 177 patients who underwent surgical treatment in our hospital due to"suspected ovarian metastasis of colorectal cancer"were retrospectively analyzed,and they were divided into the metastasis group(n=132)and the non-metastasis group(n=45)according to pathological diagnosis,by Kaplan-Meier survival analysis,Log-rank test,univariate prognosis analysis.The multivariate prognosis analysis was used with Cox model.Results Compared with the non-metastasis group,the mean age of the metastasis group was significantly younger[(47.64±13.58)years vs(52.33±13.08)years,t=2.023,P=0.045],the preoperative mean serum CA125 level was significantly increased(29.90 U/mL vs 13.10 U/mL,t=-4.300,P<0.001),and the proportion of neoadjuvant chemotherapy and imaging positive rate were increased(55.3%vs 33%,χ^(2)=6.479,P=0.011 and 79.5%vs 7%,χ^(2)=4.936,P=0.0115).In the metastasis group,the moderately differentiated adenocarcinoma had the highest proportion of ovarian metastasis(60.6%),followed by the mucinous adenocarcinoma/signet-ring cell carcinoma(23.5%),highly differentiated adenocarcinoma(9.1%),poorly differentiated adenocarcinoma(6.8%);the highest proportion of primary tumor sites was showed in descending colon/sigmoid colon(40.2%),followed by rectum(24.2%),ascending colon(23.5%),and transverse colon(12.1%).Compared with the non-metastasis group,the proportion of peritoneal metastasis was significantly lower in the metastasis group(31.8%vs 62%,χ^(2)=12.976,P<0.001).The 60 months survival rate between the metastasis group and the non-metastasis group was similar(30%vs 45%,P=0.851).Univariate analysis showed age(OR=1.027),positive imaging(OR=54.44),serum CA125 level(OR=0.992),neoadjuvant chemotherapy(OR=2.475),tumor location in the colon/rectum(OR=3.633/3.509),and peritoneal metastasis(OR=0.283)as influencing factors(all P<0.05).Mult

关 键 词：结直肠癌 卵巢转移 预后 预防性切除 

分 类 号：R735.34[医药卫生—肿瘤]