摘要
目的分析结直肠癌(CRC)患者不确定肺结节(IPN)的随访变化情况与结节良恶性的关系,探讨预测IPN变化的影响因素。方法收集2014年1月至2020年1月于贵州医科大学附属医院结直肠肛门外科就诊的228例CRC合并IPN患者的临床资料,分析影响CRC合并IPN患者IPN变化的因素。结果在CRC合并IPN的患者中,随访期间IPN无变化患者占78.5%(179/228)、IPN增大增多患者占12.3%(28/228)、IPN缩小消失患者占9.2%(21/228),增大增多患者的IPN均经临床或病理诊断为转移性病灶,无变化及缩小消失患者IPN在随访期内未能明确良恶性。单因素分析结果显示,三组CRC合并IPN患者初诊时癌胚抗原(CEA)、随访期间CEA和糖类抗原19-9(CA19-9)、N分期、M分期比较差异有统计学意义(P<0.01),而三组原发肿瘤部位、初诊时CA19-9、结节特征、T分期、化疗情况比较差异无统计学意义(P>0.05)。多因素回归分析结果显示,初诊和随访期间N_(1)分期、随访期间CEA升高是IPN增大增多的独立危险因素(P<0.05),但初诊和随访期间CEA升高、N_(1)、N_(2)、M_(1)分期以及随访期间CA19-9升高均不是IPN缩小消失的独立危险因素(P>0.05)。结论N_(1)期以及随访期间CEA升高CRC患者的IPN更易出现增大增多改变,并可能为转移性病变。
Objective To analyze the relationship between the follow-up changes and the benign or malignant of indeterminate pulmonary nodules(IPN)in patients with colorectal cancer(CRC),explore the clinical factors in predicting changes of these nodules.Methods The clinical data of 228 patients with colorectal cancer and indeterminate pulmonary nodules were collected from the Department of Colorectal and Anal Surgery,Affiliated Hospital of Guizhou Medical University from Jan.2014 to Jan.2020,and the factors affecting the changes of IPN in patients with CRC and IPN were analyzed.Results Among these patients with CRC and IPN,78.5%(179/228)patients with no change in IPN during follow-up,12.3%(28/228)with enlarged and increased in IPN,and 9.2%(21/228)with reduction and disappearance.Among them,all indeterminate pulmonary nodules in patients in group of enlarged and increased were diagnosed as metastatic lesions,while the indeterminate pulmonary nodules in group of no change or reduced and disappeared could not be determined into benign or malignant during the follow-up period.Univariate analysis showed that there were statistically significant differences in initial carcinoembryonic antigen(CEA),CEA and carbohydrate antigen 19-9(CA19-9)during follow up,N staging and M staging among CRC patients with IPN in the three groups(P<0.01).There were no significant differences in the site of primary tumor,initial CA19-9,nodule characteristics,T staging and chemotherapy among the three groups(P>0.05).Multivariate regression analysis showed that N_(1) staging during initial diagnosis and follow-up and CEA increase during follow-up were independent risk factors for IPN increase(P<0.05),but the elevation of CEA,N_(1),N_(2) and M_(1) staging during initial diagnosis and follow-up,and the elevation of CA19-9 during follow-up were not independent risk factors for IPN reduction and disappearance(P>0.05).Conclusion The indeterminate pulmonary nodules are more likely to increase and enlargement and then be proved as metastatic lesions in patients
作者
吴洪俊
李国胜
WU Hongjun;LI Guosheng(Guizhou Medical University,Guiyang 550004,China;Department of Colorectal and Anal Surgery,Affiliated Hospital of Guizhou Medical University,Guiyang 550004,China)
出处
《医学综述》
CAS
2022年第6期1240-1244,共5页
Medical Recapitulate
关键词
结直肠癌
不确定肺结节
肺转移
随访变化
Colorectal cancer
Indeterminate pulmonary nodule
Pulmonary metastasis
Follow-up change
