摘要
目的探讨T1、T2期直肠癌淋巴结转移的危险因素,并构建预测模型。方法回顾性分析行根治性切除并病理证实肿瘤未浸润浆膜的250例T1、T2期直肠癌患者的临床病理资料。采用Cox回归模型分析影响淋巴结转移的危险因素,并构建淋巴转移(LM)指数方程。结果 250例中T1期51例,T2期199例,淋巴结转移53例(21.2%)。单因素分析显示肿瘤浸润、分化程度、肿块类型、术前癌胚抗原(CEA)及术前糖链抗原(CA199)与淋巴结转移有关(均P <0.05);多元逐步Cox回归分析显示肿瘤分化程度、溃疡型肿块、术前CEA和CA199水平异常是T1、T2期直肠癌淋巴结转移的独立危险因素(均P <0.05)。淋巴转移指数方程为:LM=0.301X1+0.244X2+0.361X3+0.378X4(LM越大,转移风险越高)。结论 T1、T2期直肠癌发生淋巴结转移的风险较高,肿瘤分化程度、溃疡型肿块、术前CEA和CA199水平异常是淋巴结转移的独立危险因素。本研究建立了淋巴结转移指数方程,对指导临床高危人群的干预有重要意义。
Objective To investigate the risk factors of lymph node metastasis in T1 and T2 rectal cancer and to establish a predictive model.Methods The clinical and pathological data of 250 patients with T1 and T2 rectal cancer who underwent radical resection and pathologically confirmed tumor infiltration were retrospectively analyzed.Cox regression model was used to analyze the risk factors of lymph node metastasis in patients with univariate and multivariate analysis,and the index equation of lymph node metastasis(LM)was constructed.Results Of the 250 patients,51were in T1 stage,and 199were in stage T2,and therewere 53(21.2%)with lymph nodemetastasis.Univariate Cox regression analysis showed that tumor invasion,differentiation,tumor type,preoperative CEA and preoperative CA199 were related to lymph nodemetastasis(all P<0.05).Furthermore,multiple stepwise Cox regression analysis showed that the abnormal levels of tumor differentiation,ulcerative mass,preoperative CEA and CA199 were independent risk factors of metastasis(all P<0.05).The equation of lymph metastasis index was LM=0.301X1+0.244X2+0.361X3+0.378X4(the larger the LM,the higher the risk of metastasis).Conclusions The risk of lymph node metastasis in T1 and T2 rectal cancer is higher.Poor differentiation,ulcerative mass,and abnormal CEA and CA199 levels are independent risk factors for lymph node metastasis.The index equation of lymph node metastasis was established in this study,which is significant for guiding the intervention of high-risk population.
作者
杨大庆
周晓聪
李日增
夏建福
周宏
YANG Daqing;ZHOU Xiaocong;LI Rizeng;XIA Jianfu;ZHOU Hong(Wenzhou Central Hospital,Wenzhou 325000,Zhejiang,China)
出处
《现代实用医学》
2018年第12期1576-1578,1591,共4页
Modern Practical Medicine
基金
温州市科技计划项目(Y20170418)
关键词
直肠癌
淋巴结转移
危险因素
预测模型
Rectal cancer
Lymph node metastasis
Risk factors
Prediction model
