摘要
目的探讨结直肠癌病人术后出现腹膜转移的影响因素及预后情况。方法回顾性分析中国人民解放军联勤保障部队第九〇九医院2018年1月至2021年12月收治的216例结直肠癌术后病人临床资料,根据是否出现腹膜转移分为转移组(n=31)和未转移组(n=185)。分析2组病人临床资料,采用单因素和logsitic多因素分析结直肠癌术后腹膜转移影响因素。根据多因素分析结果绘制受试者操作特征曲线分析多因素模型对结直肠癌术后腹膜转移的预测效能。采用Kaplan-Meier法进行生存分析腹膜转移病人对预后的影响,并进行log-rank检验。结果与未转移组相比,转移组术前肠梗阻、肿瘤长径≥5 cm、T_(3~4)分期、N_(1~2)分期、癌结节、脉管侵犯、神经侵犯、切缘阳性、错配修复蛋白缺失、微卫星不稳定比例高于未转移组(均P<0.05)。多因素分析结果发现术前肠梗阻(OR=3.075,95%CI:1.023~9.422)、肿瘤长径≥5 cm(OR=3.490,95%CI:1.302~9.359)、T_(3~4)分期(OR=3.944,95%CI:1.526~10.196)、N_(1~2)分期(OR=3.100,95%CI:1.197~8.028)、神经侵犯(OR=3.634,95%CI:1.157~11.416)是结肠癌术后腹膜转移的独立危险因素。多因素分析模型预测结直肠癌术后腹膜转移,受试者操作特征曲线分析发现曲线下面积为0.858(95%CI:0.791~0.924,P<0.001)。绘制生存曲线分析发现,腹膜转移病人生存时间短于肝转移、肺转移和脑、骨转移病人(P<0.001)。结论术前肠梗阻、肿瘤长径≥5 cm、T_(3~4)分期、N_(1~2)分期、神经侵犯是结肠癌术后腹膜转移的独立危险因素,腹膜转移病人预后较差、生存期较短。
Objective To investigate the influencing factors and prognosis of postoperative peritoneal metastasis in patients with colorectal cancer(CRC).Methods The clinical data of 216 postoperative CRC patients admitted to the 909th Hospital from January 2018 to December 2021 were retrospectively analyzed.According to the presence or absence of peritoneal metastasis,patients were allocated to peritoneal metastases group(n=31)and non-peritoneal metastases group(n=185).The clinicopathological features of patients with peritoneal metastases were analyzed,and the influencing factors for postoperative peritoneal metastasis were analyzed by univariate and multivariate logistic regression.The prediction value of the multivariate logistic regression model in postoperative peritoneal metastasis in CRC patients was assessed by plotting the receiver operating characteristic curve.Kaplan-Meier method was used to analyze the prognosis of CRC patients with postoperative peritoneal metastasis,and log-rank test was performed.Results Compared with the non-peritoneal metastases group,the proportions of preoperative intestinal obstruction,tumor length≥5 cm,T_(3-4) stage,N_(1-2) stage,cancer nodules,vascular invasion,nerve invasion,positive incisal margin,mismatch repair protein deletion and microsatellite instability in the peritoneal metastases group were significantly higher(P<0.05).Multivariate logistic regression analysis showed that preoperative intestinal obstruction(OR=3.075,95%CI:1.023-9.422),tumor length≥5 cm(OR=3.490,95%CI:1.302-9.359),and T_(3-4) stage(OR=3.944,95%CI:1.526-10.196),N_(1-2) stage(OR=3.100,95%CI:1.197-8.028),and neuroinvasion(OR=3.634,95%CI:1.157-11.416)were independent risk factors for postoperative peritoneal metastasis in CRC patient.The area under the curve of the multivariate logistic regression model in predicting postoperative peritoneal metastasis in CRC patients was 0.858(95%CI:0.791-0.924,P<0.001).The Kaplan-Meier analysis showed that the survival time of CRC patients with postoperative peritoneal metastasis was significantly shorter than that of patients with liver metastasis,lung metastasis,brain metastasis and bone metastasis(P<0.001).Conclusions Preoperative intestinal obstruction,tumor diameter≥5 cm,T_(3-4) stage,N_(1-2) stage,and nerve invasion are independent risk factors for postoperative peritoneal metastasis of CRC.Patients with peritoneal metastasis have a worse prognosis and shorter survival time.
作者
陈羡英
罗丽丹
代玉娟
陈大朝
Chen Xianying;Luo Lidan;Dai Yujuan;Chen Dachao(Department of Oncology,the 909th Hospital of the Joint Logistic Support Force of the Chinese People's Liberation Army,Dongnan Hospital of Xiamen University,Fujian Zhangzhou 363000,China)
出处
《腹部外科》
2025年第4期274-278,285,共6页
Journal of Abdominal Surgery
关键词
结直肠癌
结直肠癌根治术
病理特征
腹膜转移
预后
Colorectal cancer
Radical resection of colorectal cancer
Pathological features
Peritoneal metastasis
Prognosis
