Ⅲc期结直肠癌根治术后复发转移的危险因素分析  

Analysis of risk factors for recurrence and metastasis after radical surgery for stage Ⅲc colorectal cancer

作　　者：许东[1] 谢逸林 路慧欣 程坦坦 卢传辉[5] 苏国强[5] 黎凡 XU Dong;XIE Yi-lin;LU Hui-xin;CHENG Tan-tan;LU Chuan-hui;SU Guo-qiang;LI Fan(Department of Gastroenterology,the First Affiliated Hospital of Xiamen University,School of Medicine,Xiamen University,Xiamen 361000,China;Endoscopy Center,the First Affiliated Hospital of Xiamen University,School of Medicine,Xiamen University,Xiamen 361000,China;Department of Breast Surgery,Fudan University Shanghai Cancer Center Xiamen Hospital,Xiamen 361102,China;School of Public Health,Xiamen University,Xiamen 361102,China;Department of Colorectal Cancer Surgery,the First Affiliated Hospital of Xiamen University,School of Medicine,Xiamen University,Xiamen 361000,China)

机构地区：[1]厦门大学附属第一医院消化内科,福建厦门361000 [2]厦门大学附属第一医院内镜中心,福建厦门361000 [3]复旦大学附属肿瘤医院厦门医院乳腺外科,福建厦门361102 [4]厦门大学公共卫生学院,福建厦门361102 [5]厦门大学附属第一医院结直肠肿瘤外科,福建厦门361000

出　　处：《中国实用外科杂志》2025年第2期202-207,共6页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金项目(No.81970462);厦门市医疗卫生重点项目(No.3502Z20204001)。

摘　　要：目的 探讨Ⅲc 期结直肠癌根治术后复发转移的危险因素。方法 回顾性分析 2016 年 7 月至 2022 年 6月期间,厦门大学附属第一医院结直肠肿瘤外科收治的 115 例行根治性手术且病理学检查结果证实为 TNM Ⅲc期结直肠癌病人的临床资料。根据随访过程中是否发生复发或者转移,将病人分为无复发转移组(66例)和复发转移组(49例)。单因素和多因素 Cox比例风险回归分析复发转移相关的危险因素。结果 无复发转移组与复发转移组在 CEA、CA19-9、T 分期、癌结节数目、转移淋巴结比例及根部淋巴结转移状态方面差异具有统计学意义(P<0.05)。多因素分析结果显示,CEA>5 μg/L[HR=2.288,95%CI(1.222~4.286),P=0.010]、转移淋巴结比例>0.412[HR=2.100,95%CI(1.060~4.159),P=0.033]和根部淋巴结阳性[HR=1.894,95%CI(1.042~3.440),P=0.036]是病理Ⅲc期结直肠癌复发转移的独立危险因素。累积生存率比较显示,CEA>5 μg/L组低于 CEA ≤5 μg/L组(χ^(2)=9.282,P<0.002),转移淋巴结比例>0.412 组低于转移淋巴结比例≤0.412 组(χ^(2)=11.234,P<0.001),根部淋巴结转移阳性组低于根部淋巴结转移阴性组(χ^(2)=9.674,P<0.001),差异有统计学意义。平均随访时间(42.5±20.1)个月,3 年无瘤生存时间(DFS)为(29.9±22.0)个月。根部淋巴结阳性者,3 年复发率达 55.6%,DFS 为 21.2 个月。转移淋巴结比例>0.412 者 3 年复发率达 59.6%,DFS 为 15.9 个月。CEA>5 μg/L、根部淋巴结阳性且转移淋巴结比例>0.412 者 3 年复发率达 100%,DFS 仅为 13.2 个月。结论 CEA>5 μg/L、转移淋巴结比例>0.412 和根部淋巴结阳性是病理Ⅲc 结直肠癌根治术后复发转移的独立危险因素。对于具有复发转移危险因素的高危人群,应高度重视,并及时干预。Objective To analyze the risk factors for recurrence and metastasis after radical surgery for stageⅢc colorectal cancer (CRC).Methods A retrospective analysis was conducted on the clinical data of 115 patients with CRC who underwent radical surgery and were pathologically confirmed as TNM stageⅢc at the Department of Colorectal Oncology of the First Affiliated Hospital of Xiamen University from July 2016 to June 2022.Based on whether metastasis or recurrence occurred during the 5-year followup,the patients were divided into a tumor-free group (66 cases) and the tumor-bearing group (49cases).Univariate and multivariate analyses were performed on various clinical data between the two groups using the Cox proportional hazards regression model to screen out the risk factors for recurrence and metastasis.Results There were statistically significant differences in CEA,CA19-9,T stage,the number of cancerous nodes,the proportion of metastatic lymph nodes,and the status of root lymph node metastasis between the tumor-free group and the tumor-bearing group(P<0.05).The results of multivariate analysis showed that CEA>5μg/L (HR=2.288,95%CI 1.222-4.286,P=0.01),the proportion of metastatic lymph nodes>0.412 (HR=2.1,95%CI 1.060-4.159,P=0.033),and the positive status of root lymph node metastasis (HR=1.894,95%CI 1.042-3.440,P=0.036) were risk factors for recurrence and metastasis of stageⅢc CRC.In the comparison of cumulative survival curves,for the group with CEA>5μg/L,the survival time is shorter than that of the group with CEA≤5μg/L(χ^(2)=9.282,P<0.002),with a statistically significant difference;for the group with the proportion of metastatic lymph nodes>0.412,the survival time is shorter than that of the group with the proportion of metastatic lymph nodes≤0.412 (χ^(2)=11.234,P<0.001),with a statistically significant difference;for the group with positive root lymph node metastasis,the survival time is shorter than that of the group with negative root lymph node metastasis(χ^(2)=9.674,P<0.001),with a statisti

关 键 词：结直肠癌 Ⅲ期 转移淋巴结比例 根部淋巴结转移 CEA 

分 类 号：R6[医药卫生—外科学]