T4期结肠癌病人术后2年内腹膜转移危险因素分析及临床对策  

Postoperative peritoneal metastases within 2 years in patients with T4 colon cancer:analysis of risk factors and clinical therapeutic strategies

作　　者：王晔 李书原 楼征 季力强 李世昊 辛诚 刘连杰 郝立强 张卫 WANG Ye;LI Shu-yuan;LOU Zheng(Department of Colorectal Surgery,the First Affiliated Hospital of Naval Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学第一附属医院肛肠外科,上海200433

出　　处：《中国实用外科杂志》2024年第10期1159-1164,共6页Chinese Journal of Practical Surgery

基　　金：2023年度上海市“科技创新行动计划”项目(No.23DZ2202000)。

摘　　要：目的分析非转移性T4期结肠癌病人术后2年内发生腹膜转移的影响因素,并总结临床对策。方法回顾性分析2015-01-01至2021-12-31海军军医大学第一附属医院肛肠外科收治的行结肠切除术的292例T4期结肠癌病人临床病理资料,采用Cox回归分析影响术后2年内腹膜转移的因素。结果单因素分析显示,BMI、术后病理N分期、癌结节、脉管癌栓、BRAF基因型、手术方式与术后2年内腹膜转移相关(P<0.05);多因素分析显示,BMI≥30(HR=4.881,95%CI 1.272-18.735,P=0.021)及BMI为25~<30(HR=3.040,95%CI 1.286-7.184,P=0.011)、脉管癌栓阳性(HR=4.105,95%CI 1.830-9.210,P=0.001)是术后2年内腹膜转移的独立危险因素,癌结节阳性(HR=2.135,95%CI 0.995-4.586,P=0.052)、腹腔镜手术(HR=2.061,95%CI 0.951-4.460,P=0.067)是术后2年内腹膜转移的潜在独立危险因素。结论对于非转移性T4期结肠癌病人,应慎重选择腹腔镜手术,对于BMI≥25、脉管癌栓阳性、癌结节阳性的非转移性T4期结肠癌病人,术后应定期复查,密切关注腹膜转移情况从而早期治疗、改善预后。Objective To investigate the factors influencing peritoneal metastases in patients with non-metastatic stage T4 colon cancer within 2 years after surgery and summarize the clinical therapeutic strategies.Methods Retrospectively analyze the clinical and pathological data of 292 patients with non-metastatic T4 colon cancer,who underwent colectomy at the First Affiliated Hospital of Naval Medical University from January 1,2015,to December 31,2021.Cox regression was used to analyze factors affecting peritoneal metastasis within 2 years after surgery.Results The univariate analysis showed that BMI≥30 and BMI ranging from 25 to 30,postoperative pathological N-stage,tumor deposits status,embolism of vascular cancer,BRAF genotype,and surgical method were associated with peritoneal metastasis within 2 years after surgery(P<0.05).The multivariate analysis showed that BMI≥30(HR=4.881,95%CI 1.272-18.735,P=0.021),BMI ranging from 25.0 to 30(HR=3.040,95%CI 1.286-7.184,P=0.011),and positive embolism of vascular cancer(HR=4.105,95%CI 1.830-9.210,P=0.001)were independent risk factors for peritoneal metastases within 2 years after surgery.Positive tumor deposits(HR=2.135,95%CI 0.995-4.586,P=0.052)and laparoscopic surgical approach(HR=2.061,95%CI 0.951-4.460,P=0.067)were potential independent risk factors for peritoneal metastasis within 2 years after surgery.Conclusion The laparoscopic surgical approach should be carefully selected for patients with non-metastatic T4 stage colon cancer.For non-metastatic T4 colon cancer patients with BMI≥25,positive embolism of vascular cancer,or positive tumor deposits,regular postoperative and close monitoring for peritoneal metastases should be applied for early treatment and improved prognosis.

关 键 词：T4期结肠癌 腹腔镜 腹膜转移 结肠切除术 影响因素 

分 类 号：R6[医药卫生—外科学]