中国普外基础与临床杂志

中国普外基础与临床杂志

T1期直肠癌淋巴结转移危险因素分析

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目的 探讨影响 T1 期直肠癌淋巴结转移的危险因素。 方法 采用回顾性病例对照研究方法。收集 2000 年 1 月至 2016 年 12 月期间四川大学华西医院收治并接受根治性手术的 247 例原发性 T1 期直肠癌患者的临床病理资料,包括肿瘤大小(最大直径)、大体类型、分化程度、组织学类型、脉管浸润、神经浸润、癌结节及清扫淋巴结数量。单因素分析采用 χ2 检验,多因素分析采用 logistic 回归模型。 结果 247 例原发性 T1 期直肠癌患者中 21(8.50%)例发生淋巴结转移,其中高分化 T1 期直肠癌患者未发生淋巴结转移。影响 T1 期直肠癌淋巴结转移的单因素分析结果显示,直肠癌的分化程度、组织学类型及癌结节与 T1 期直肠癌淋巴结转移有关(P<0.05);进一步的多因素分析结果显示,肿瘤低分化、黏液腺癌、印戒细胞癌及伴有癌结节是 T1 期直肠癌淋巴结转移的独立危险因素(OR=9.75、P=0.006,OR=5.98、P=0.042,OR=8.33、P=0.017,OR=10.87、P=0.026)。 结论 肿瘤低分化、黏液腺癌、印戒细胞癌及伴有癌结节是 T1 期直肠癌淋巴结转移的独立危险因素。

Objective To explore risk factors of lymph node metastasis (LNM) in T1 rectal cancer. Methods The retrospective case-control study was conducted. The clinicopathologic data of 247 patients with T1 rectal cancer underwent radical resection were analyzed in the pathological database of the West China Hospital from January 2000 to December 2016, including the tumor size (maximum diameter), gross type, differentiation degree, histological type, lymphvascular infiltration, perineural infiltration, tumor deposit, and number of lymph node retrieved. The univariate analysis and multivariate analysis were done using the chi-square test and logistic regression model, respectively. Results The rate of LNM in the T1 rectal cancer was 8.50% (21/247). No lymph metastasis was found in the well differentiated T1 rectal cancer. The results of the univariate analysis showed that the differentiation degree, histological type, and tumor deposit were related to the LNM in the T1 rectal cancer (P<0.05). The results of the multivariate analysis revealed that the poor differentiation, mucinous adenocarcinoma, signet-ring cell carcinoma, and tumor deposit were the independent risk factors of the LNM in the T1 rectal cancer (OR=9.75, P=0.006; OR=5.98, P=0.042; OR=8.33, P=0.017; OR=10.87, P=0.026). Conclusion In this large population dataset, poor differentiation, mucinous adenocarcinoma, signet-ring cell carcinoma, and tumor deposit are risk factors of LNM in T1 rectal cancer.

关键词: T1期直肠癌; 淋巴结转移; 危险因素; 局部切除术

Key words: T1 rectal cancer; lymph node metastasis; risk factor; local resection

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