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中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2020, Vol. 09 ›› Issue (02) : 137 -143. doi: 10.3877/cma.j.issn.2095-3224.2020.02.006

所属专题： 文献；

论著

探讨癌结节在结直肠癌患者术后病理分期中的意义及其对预后的价值研究
胡正宇1, 李彦2, 陈博1, 杨群树1, 齐向咏1, 孟翔凌1,†()   
  1. 1. 230022　合肥，安徽医科大学第一附属医院胃肠外科
    2. 230022　合肥，安徽医科大学第一附属医院肿瘤放疗科
  • 收稿日期:2019-07-17 出版日期:2020-04-25
  • 通信作者: 孟翔凌
  • 基金资助:
    安徽省科技计划项目(No. 1607a0202020)

Study of tumor deposits′ application in postoperative pathologic staging definition and the prognostic value in colorectal cancer patients

Zhengyu Hu1, Yan Li2, Bo Chen1, Qunshu Yang1, Xiangyong Qi1, Xiangling Meng1,†()   

  1. 1. Department of Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
    2. Department of Radiotherapy, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
  • Received:2019-07-17 Published:2020-04-25
  • Corresponding author: Xiangling Meng
  • About author:
    Corresponding author: Meng Xiangling, Email:
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引用本文：

胡正宇, 李彦, 陈博, 杨群树, 齐向咏, 孟翔凌. 探讨癌结节在结直肠癌患者术后病理分期中的意义及其对预后的价值研究[J]. 中华结直肠疾病电子杂志, 2020, 09(02): 137-143.

Zhengyu Hu, Yan Li, Bo Chen, Qunshu Yang, Xiangyong Qi, Xiangling Meng. Study of tumor deposits′ application in postoperative pathologic staging definition and the prognostic value in colorectal cancer patients[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2020, 09(02): 137-143.

目的

研究结直肠癌手术患者术后病理中癌结节的检出与患者预后的关系，探讨更加详细、合理的分期方法。

方法

收集2012年1月至2013年12月于安徽医科大学第一附属医院普外科行结直肠癌切除术的361例患者的临床及随访资料，采用Kaplan-Meier生存曲线比较生存差异，COX单因素和多因素分析影响结直肠癌患者预后的相关因素。

结果

术后病理中癌结节检出与否和肿瘤的分化程度、肿瘤的浸润深度（T）、pTNM分期、CEA、CA19-9相关，差异具有统计学意义（均P<0.05）；单因素分析癌结节阴性患者生存时间长于癌结节阳性患者，差异具有统计学意义（χ2=10.805，P<0.05）；将N0、N1c、N1和N2的患者进行生存比较，发现N1c和N1的患者之间差异无统计学意义（χ2=0.580，P>0.05）；随着癌结节数目的增加，患者的生存预后越差；当把癌结节当成转移淋巴结时，得到新的分期与第八版TNM分期的生存比较存在差异：当对癌结节数目、转移淋巴结数目和总检出淋巴结数目进行研究时发现，随着阳性结节比值（癌结节数＋转移淋巴结数）/（癌结节数＋病理检出淋巴结总数）的增加，患者的预后也随之变差（59.4 vs. 58.2 vs. 36.0 vs. 28.7，χ2=15.389；P=0.002）。

结论

癌结节的状态是影响结直肠癌患者预后的重要因素，将癌结节及转移淋巴结均定义为阳性结节后，阳性结节比值越高的患者预后越差；阳性结节比值可作为评估结直肠癌患者TNM分期中的重要补充，为指导日后治疗提供更准确的依据。

关键词: 结直肠肿瘤, 癌结节, TNM分期, 预后
Objective

Our study aims to investigate the relationship between postoperative pathological tumor deposits and the prognosis of patients with colorectal cancer surgery, investigating a detailed and reasonable method in tumor staging.

Methods

The clinical and follow-up data of 361 patients who underwent colorectal cancer resection in the General Surgery Department of the First Affiliated Hospital of Anhui Medical University from January 2012 to December 2013 were collected. Kaplan-Meier survival curve was used to compare the survival differences. Cox single factor and multi factor analysis were used to analyze the related factors affecting the prognosis of colorectal cancer patients.

Results

Postoperative tumor deposits positive or not was related to the degree of tumor differentiation, tumor infiltration depth (T), pTNM, CEA and CA19-9, founding statistical significance (all P<0.05). The survival time of patients with tumor deposits negative was higher than that of patients with tumor deposits positive in univariate ananlysis (χ2=10.805, P<0.05). After analyzing, we found that patients with stage N1 and N1c having no survival different (χ2=0.580, P>0.05). However, when the number of tumor deposits was increasing, the survival prognosis of patients was getting worse. When the tumor deposits were treated as metastatic lymph nodes, modified staging was obtained and having statistical difference from the 8th editing TNM staging. When it comes to the number of tumor deposits, metastatic lymph nodes number and the detected total lymph nodes number, we found that patients with high positive nodes ratio (tumor deposits+ metastatic lymph nodes)/(total number of all nodes) have bad survival outcomes (59.4 vs. 58.2 vs. 36.0 vs. 28.7, χ2=15.389; P=0.002).

Conclusions

Tumor deposits status are the important factor affecting the prognosis of patients with colorectal cancer. When we defining positive tumor deposits and metastatic lymph nodes as positive nodes, the patients with high positive nodes ratio would have bad prognosis. Positive nodes ratio can be used as important supplement for TNM staging of colorectal cancer patients, providing a more accurate basis for guiding treatment in the future.

Key words: Colorectal neoplasms, Tumor deposit, Stage TNM, Prognosis
表1 癌结节与结直肠癌患者临床特征的相关性分析
临床特征 癌结节 χ2值 P值
阴性 阳性
年龄（岁） ? ? 3.99 0.046
? ≤60 133 40 ? ?
? >60 160 28 ? ?
性别 ? ? 2.09 0.148
? 男 183 36 ? ?
? 女 110 32 ? ?
肿瘤最大径（cm） ? ? 2.08 0.149
? ≤5 223 46 ? ?
? >5 70 22 ? ?
肿瘤位置 ? ? 2.53 0.112
? 结肠 152 28 ? ?
? 直肠 141 40 ? ?
大体形态 ? ? 5.51 0.064
? 隆起型 84 12 ? ?
? 溃疡型 186 46 ? ?
? 浸润型 23 10 ? ?
肿瘤分化 ? ? 4.97 0.026
? 高分化 15 0 ? ?
? 中分化 226 50 ? ?
? 低分化 52 18 ? ?
T分期 ? ? 5.91 0.015
? T1 15 0 ? ?
? T2 38 4 ? ?
? T3 200 52 ? ?
? T4 40 12 ? ?
N分期 ? ? 4.77 0.092
? N0 209 40 ? ?
? N1 66 20 ? ?
? N2 18 8 ? ?
TNM ? ? 106.17 <0.0001
? Ⅰ 53 0 ? ?
? Ⅱ 146 0 ? ?
? Ⅲ 90 66 ? ?
? Ⅳ 4 2 ? ?
CEA（ng/mL） ? ? 33.39 0.001
? <5.00 172 24 ? ?
? ≥5.00 121 44 ? ?
CA19-9（KU/L） ? ? 12.19 <0.0001
? <35.00 225 28 ? ?
? ≥35.00 68 40 ? ?
图1 癌结节阳性与阴性结直肠癌患者的生存差异
图2 N1c与N0、N1、N2生存时间比较。2A：N0与N1c的比较；2B：N1c与N1的比较；2C为N1c与N2的比较
图3 癌结节个数对结直肠癌患者预后的影响。3A：癌结节个数临界值为1时预后的比较；3B：癌结节个数临界值为2时预后的比较；3C：癌结节个数临界值为5时预后的比较　注：TD：tumor deposits（癌结节）
表2 不同癌结节数量（1，2，5个）时两组的HR值及95% CI
分组 例数 5年总生存率 P值 HR 95%CI
癌结节=1个 48 50.0% 0.050 1 0.980~3.671
癌结节>1个 20 25.0% 1.896
癌结节≤2个 58 50% 0.001 1 1.610~7.361
癌结节>2个 10 0.0% 3.443
癌结节≤5个 60 48.3% <0.001 1 1.599~8.637
癌结节>5个 8 0.0% 3.716
图4 癌结节定义为转移淋巴结后，改良IIIC期与原ⅢC期患者的生存比较
图5 阳性结节比值（50%）对结直肠癌患者预后的比较
图6 阳性结节比值对结直肠癌患者预后的比较
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