中国实用外科杂志

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (02): 202-207.DOI: 10.19538/j.cjps.issn1005-2208.2025.02.13

• 论著 • 上一篇    下一篇

Ⅲc期结直肠癌根治术后复发转移的危险因素分析

许    东1，谢逸林2，路慧欣3，程坦坦4，卢传辉5，苏国强5，黎    凡5   

  1. 1 厦门大学附属第一医院消化内科，福建厦门 361000；2厦门大学附属第一医院内镜中心，福建厦门 361000；3 复旦大学附属肿瘤医院厦门医院乳腺外科，福建厦门 361102；4 厦门大学公共卫生学院，福建厦门 361102；5 厦门大学附属第一医院结直肠肿瘤外科，福建厦门 361000
  • 出版日期:2025-02-01 发布日期:2025-02-26

  • Online:2025-02-01 Published:2025-02-26

摘要： 目的    探讨Ⅲc期结直肠癌根治术后复发转移的危险因素。方法    回顾性分析2016年7月至2022年6月期间，厦门大学附属第一医院结直肠肿瘤外科收治的115例行根治性手术且病理学检查结果证实为TNM Ⅲc期结直肠癌病人的临床资料。根据随访过程中是否发生复发或者转移，将病人分为无复发转移组（66例）和复发转移组（49例）。单因素和多因素Cox比例风险回归分析复发转移相关的危险因素。结果    无复发转移组与复发转移组在CEA、CA19-9、T分期、癌结节数目、转移淋巴结比例及根部淋巴结转移状态方面差异具有统计学意义（P＜0.05）。多因素分析结果显示，CEA＞5 μg/L［HR=2.288，95%CI（1.222~4.286），P=0.010］、转移淋巴结比例＞0.412［HR=2.100，95%CI（1.060~4.159），P=0.033］和根部淋巴结阳性［HR=1.894，95%CI（1.042~3.440），P=0.036］是病理Ⅲc期结直肠癌复发转移的独立危险因素。累积生存率比较显示，CEA＞5 μg/L组低于CEA ≤5 μg/L组（χ²=9.282，P＜0.002），转移淋巴结比例＞0.412组低于转移淋巴结比例≤0.412组（χ²=11.234，P＜0.001），根部淋巴结转移阳性组低于根部淋巴结转移阴性组（χ²=9.674，P＜0.001），差异有统计学意义。平均随访时间（42.5±20.1）个月，3年无瘤生存时间（DFS）为（29.9±22.0）个月。根部淋巴结阳性者，3年复发率达55.6%，DFS为21.2个月。转移淋巴结比例＞0.412者3年复发率达59.6%，DFS为15.9个月。CEA＞5 μg/L、根部淋巴结阳性且转移淋巴结比例＞0.412者3年复发率达100%，DFS仅为13.2个月。结论    CEA＞5 μg/L、转移淋巴结比例＞0.412和根部淋巴结阳性是病理Ⅲc结直肠癌根治术后复发转移的独立危险因素。对于具有复发转移危险因素的高危人群，应高度重视，并及时干预。

关键词: 结直肠癌, Ⅲ期, 转移淋巴结比例, 根部淋巴结转移, CEA 

Abstract: To analyze the risk factors for recurrence and metastasis after radical surgery for stage Ⅲc colorectal cancer (CRC). Methods    A retrospective analysis was conducted on the clinical data of 115 patients with CRC who underwent radical surgery and were pathologically confirmed as TNM stage Ⅲc at the Department of Colorectal Oncology of the First Affiliated Hospital of Xiamen University from July 2016 to June 2022. Based on whether metastasis or recurrence occurred during the 5-year follow-up, the patients were divided into a tumor-free group (66 cases) and the tumor-bearing group (49 cases). Univariate and multivariate analyses were performed on various clinical data between the two groups using the Cox proportional hazards regression model to screen out the risk factors for recurrence and metastasis. Results    There were statistically significant differences in CEA, CA19-9, T stage, the number of cancerous nodes, the proportion of metastatic lymph nodes, and the status of root lymph node metastasis between the tumor-free group and the tumor-bearing group
(P<0.05). The results of multivariate analysis  showed that CEA>5 μg/L (HR=2.288, 95%CI 1.222-4.286, P=0.01), the proportion of metastatic lymph nodes >0.412 (HR=2.1, 95%CI 1.060-4.159, P=0.033), and the positive status of root lymph node metastasis (HR=1.894, 95%CI 1.042-3.440, P=0.036) were risk factors for recurrence and metastasis of stage Ⅲc CRC. In the comparison of cumulative survival curves, for the group with CEA>5 μg/L, the survival time is shorter than that of the group with CEA≤5 μg/L(χ²=9.282, P<0.002), with a statistically significant difference; for the group with the proportion of metastatic lymph nodes > 0.412, the survival time is shorter than that of the group with the proportion of metastatic lymph nodes ≤0.412 (χ²=11.234, P<0.001), with a statistically significant difference; for the group with positive root lymph node metastasis, the survival time is shorter than that of the group with negative root lymph node metastasis(χ²=9.674, P<0.001), with a statistically significant difference. The average follow-up time was (42.5±20.1) months, and the 3-year disease-free survival (DFS) time was (29.9±22.0) months. When the root lymph nodes were positive, the 3-year recurrence rate reached 55.6%, and the DFS was 21.2 months. When the proportion of metastatic lymph nodes was >0.412, the 3-year recurrence rate reached 59.6%, and the DFS was 15.9 months. When patients with CEA>5 μg/L, positive root lymph nodes, and the proportion of metastatic lymph nodes >0.412, the 3-year recurrence rate reached 100%, and the DFS was only 13.2 months. Conclusion    CEA>5 μg/L, the proportion of metastatic lymph nodes >0.412, and positive root lymph nodes are independent risk factors for recurrence and metastasis following radical resection of pathological stage Ⅲc CRC. Patients with these risks should gain great attention and timely intervene.

Key words: colorectal cancer, stage Ⅲ, proportion of metastatic lymph nodes, root lymph node metastasis, carcinoembryonic antigen