中国实用外科杂志

中国实用外科杂志

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CT诊断壁外血管侵犯联合CA19-9对Ⅲ期结肠癌病人预后预测价值研究

周    静a，姚    旬b，张    辉a，崔艳成a，申占龙a，叶颖江a，王    屹b，王    杉a   

  1. 北京大学人民医院 a. 胃肠外科 b. 放射科，北京100044
  • 出版日期:2017-01-01 发布日期:2017-01-03

  • Online:2017-01-01 Published:2017-01-03

摘要：

目的    探索增强多排螺旋CT（ceMDCT）诊断结肠癌壁外血管侵犯（EMVI）预测病人3年无病生存（DFS）的价值。方法    收集北京大学人民医院胃肠外科2009年2月至2013年12月间接受根治性手术切除并经病理学检查证实的90例原发性结肠癌病人的临床病理资料及术前影像学资料。根据术前ceMDCT影像特征确定结肠癌EMVI阳性为结肠癌块直接侵犯至结肠壁外血管腔内。Kaplan-Meier法比较结肠癌病人3年DFS差异；Cox比例风险模型单因素、多因素分析结肠癌病人3年DFS的相关因素及独立预测因素；卡方检验比较结肠癌病人的复发转移发生率。结果 根据美国癌症联合委员会（AJCC）的标准，经病理诊断为Ⅲ期的90例结肠癌病人纳入本回顾性研究。Cox多因素模型分析发现，ceMDCT诊断EMVI阳性（HR=3.266，95%CI 1.648~7.173，P=0.003）和术前血清CA19-9≥37 kU/L （HR=2.229，95%CI 1.040~4.776，P=0.039）是预测Ⅲ期结肠癌病人3年DFS的独立危险因素。EMVI阳性组及阴性组的3年DFS分别为52.8%和81.5%，二者差异具有统计学意义（P＜0.05）；EMVI阴性联合血清CA 19-9正常的病人3年复发转移发生率为10.5%，显著低于EMVI阳性联合血清CA19-9升高的病人（54.5%，P＜0.05）。结论    CT诊断EMVI阳性和术前血清CA19-9升高是Ⅲ期结肠癌术后3年DFS的独立预后危险因素，可此对Ⅲ期结肠癌可进行更准确的风险分层。

关键词: 结肠肿瘤, 壁外血管侵犯, CA19-9, 无病生存

Abstract:

PredictIve value of EMVI detected by MDCT combined with CA19-9 for prognosis of stage III  colon caner patients        ZHOU Jing*,Yao Xun,ZHANG Hui, et al.*Department of Gastroenterological Surgery,Peking University People’s Hospital, Beijing 100044，China
Corresponding author: WANG Shan, E-mail：wangshan@pkuph.edu.cn
Abstract    Objecetive    To investigate the ability of extramural vascular invasion（EMVI） in predicting 3-years disease-free survival （3yr DFS） of patients with colon cancer. Methods    Between February 2009 and December 2013， patients who had histologically proven primary colon cancer and underwent curative resection were included in this retrospective study. EMVI was defined as tumor tissue in adjacent vessels beyond colon wall on MDCT. DFS was defined as the time from the date of curative resection to the date of local recurrence， and/or distant disease， or tumor-related death. Univariate and multivariate analysis were conducted to identify prognostic factors associated with 3yr DFS. Kaplan-Meier analyses were used to compare 3yr DFS. Cox’s proportional hazards models were used to measure the impact of confounding variables on survival rates. Chi-square test was used to analyze the difference of recurrent/metastatic rate. Results    In final， 90 patients were included in this study that were identified as stage Ⅲ patients by pathology based on American Joint Committee on Cancer （AJCC）. Multivariate analysis showed that elevated serum CA19-9（HR=2.229，95%CI 1.040-4.776，P=0.039）and EMVI positive （HR=3.266，95%CI 1.648-7.173，P=0.003） were identified as independent predictors of 3yr DFS in stage Ⅲ colon cancer. Cumulative 3-year DFS were 52.8% and 81.5%（95%CI 1.648-7.173） for EMVI positive and negative patients， and 55.6% and 76.6%（95%CI 1.040-4.776） for elevated serum CA19-9 and normal serum CA19-9， significances were seen （P＜0.05）. Compared with ctEMVI positive combined with elevated serum CA19-9， 3yr recurrent/metastatic rate of ctEMVI negative combined with normal serum CA19-9 was lowerer significantly  （10.5% vs. 54.5%， P＜0.05） .Conclusion    EMVI detected with ceMDCT， and elevated serum CA19-9 level could be used as independent predictors of 3yr DFS in patients with stage Ⅲ colon cancer.

Key words: colonic neoplasms, extramural vascular invasion, carbohydrate antigen19-9, disease-free survival