中国实用外科杂志

中国实用外科杂志 ›› 2024, Vol. 44 ›› Issue (07): 793-797.DOI: 10.19538/j.cjps.issn1005-2208.2024.07.15

• 论著 • 上一篇    下一篇

局部早期结直肠癌非治愈性内镜切除后淋巴结转移预测及追加手术策略研究

赵富强，李吉云，张明光，梅世文，赵    巍，黄    飞，肖体先，郑朝旭，刘    骞   

  1. 国家癌症中心 国家肿瘤临床医学中心研究中心 中国医学科学院北京协和医学院肿瘤医院结直肠外科，北京 100021
  • 出版日期:2024-07-01 发布日期:2024-07-21

  • Online:2024-07-01 Published:2024-07-21

摘要： 目的    建立局部早期结直肠癌非治愈性内镜切除后淋巴结转移预测模型，探讨其追加手术的方式与淋巴结清扫范围。方法    回顾性分析2014年1月至2023年12月中国医学科学院肿瘤医院结直肠外科收治的行非治愈性内镜切除后追加手术的436例早期结直肠癌病人的临床病理资料。采用二元Logistic回归模型分析非治愈性内镜切除后淋巴结转移的影响因素，并构建列线图。结果    追加手术后病理检查结果示，共34例病人发生淋巴结转移。阳性淋巴结转移区域集中于第1、2站，分别为27、7例，占6.2%、1.6%；未发现第3站淋巴结转移。肿瘤分化程度及特殊病理类型（OR=0.236，95%CI 0.066-0.851，P=0.027）、肿瘤浸润深度（OR=10.138，95%CI 2.107-48.781，P=0.004）、脉管浸润（OR=9.980，95%CI 4.091-24.346，P＜0.001）和神经侵犯（OR=7.776，95%CI 3.341-18.095，P＜0.001）是淋巴结转移的独立危险因素。列线图预测模型训练集受试者工作特征曲线下面积为0.870（95%CI 0.817-0.923），校准曲线显示模型的预测结果与实际观测结果具有较好的一致性。结论    局部早期结直肠癌淋巴结转移与肿瘤分化程度及特殊病理类型、肿瘤浸润深度、脉管浸润和神经侵犯相关；对于内镜下非治愈性切除追加手术应根据原发病灶的位置和病人意愿，在规范化基础上选择个体化手术方式，兼顾根治性和功能保护，淋巴结清扫范围只需至第2站。

关键词: 局部早期结直肠癌, 内镜, 非治愈性切除, 追加手术, 淋巴结转移

Abstract: To develop a predictive model for lymph node metastasis after non-curative endoscopic resection for locally early colorectal cancer, investigate the approach and extent of lymph node dissection in subsequent surgeries. Methods    A retrospective analysis was conducted based on the clinical and pathological data of 436 patients who underwent additional surgery after non-curative endoscopic resection for locally early colorectal cancer at the Cancer Hospital, Chinese Academy of Medical Sciences between 2014 and 2023. Binary Logistic regression analysis was used to identify factors influencing lymph node metastasis after non-curative endoscopic resection, and a nomogram was constructed. Results    Pathological results after additional surgery indicated that 34 patients had lymph node metastasis. The positive lymph nodes were primarily located at the first and second stations, with 27 cases and 7 cases respectively, accounting for 6.2% and 1.6% of the total cohort. No metastasis was found at the third station. Tumor differentiation and specific case types (OR=0.236, 95%CI 0.066-0.851, P=0.027), tumor invasion depth (OR=10.138, 95%CI 2.107-48.781, P=0.004), vascular invasion (OR=9.980, 95%CI 4.091-24.346, P<0.001), and neural invasion (OR=7.776, 95%CI 3.341-18.095, P<0.001) were identified as independent risk factors for lymph node metastasis. The AUC for the nomogram prediction model in the training set was 0.870 (95%CI 0.817-0.923), and the calibration curve demonstrated good consistency between the predicted and observed results.  Conclusion    Lymph node metastasis in locally early colorectal cancer is associated with tumor differentiation, specific pathological types, tumor invasion depth, vascular invasion, and neural invasion. For additional surgery following non-curative endoscopic resection, individualized surgical approach should be selected based on the location of the primary lesion, patients’ preferences according, and standardized guidelines, balancing radicality and functional preservation, and the extent of lymph node dissection should be limited to the second station.

Key words: locally early colorectal cancer, endoscope, non-curative resection, additional surgery, lymph node metastasis