中国实用外科杂志

中国实用外科杂志 ›› 2024, Vol. 44 ›› Issue (10): 1159-1164.DOI: 10.19538/j.cjps.issn1005-2208.2024.10.16

• 论著 • 上一篇    下一篇

T4期结肠癌病人术后2年内腹膜转移危险因素分析及临床对策

王    晔，李书原，楼    征，季力强，李世昊，辛    诚，刘连杰，郝立强，张    卫   

  1. 海军军医大学第一附属医院肛肠外科，上海 200433
  • 出版日期:2024-10-01 发布日期:2024-10-24

  • Online:2024-10-01 Published:2024-10-24

摘要： 目的    分析非转移性T4期结肠癌病人术后2年内发生腹膜转移的影响因素，并总结临床对策。方法    回顾性分析2015-01-01至2021-12-31海军军医大学第一附属医院肛肠外科收治的行结肠切除术的292例T4期结肠癌病人临床病理资料，采用Cox回归分析影响术后2年内腹膜转移的因素。结果    单因素分析显示，BMI、术后病理N分期、癌结节、脉管癌栓、BRAF基因型、手术方式与术后2年内腹膜转移相关（P＜0.05）；多因素分析显示，BMI≥30（HR=4.881，95%CI 1.272-18.735，P=0.021）及BMI为25~<30（HR=3.040，95%CI 1.286-7.184，P=0.011）、脉管癌栓阳性（HR=4.105，95%CI 1.830-9.210，P=0.001）是术后2年内腹膜转移的独立危险因素，癌结节阳性（HR=2.135，95%CI 0.995-4.586，P=0.052）、腹腔镜手术（HR=2.061，95%CI 0.951-4.460，P=0.067）是术后2年内腹膜转移的潜在独立危险因素。结论    对于非转移性T4期结肠癌病人，应慎重选择腹腔镜手术，对于BMI≥25、脉管癌栓阳性、癌结节阳性的非转移性T4期结肠癌病人，术后应定期复查，密切关注腹膜转移情况从而早期治疗、改善预后。

关键词: T4期结肠癌, 腹腔镜, 腹膜转移, 结肠切除术, 影响因素

Abstract: To investigate the factors influencing peritoneal metastases in patients with non-metastatic stage T4 colon cancer within 2 years after surgery and summarize the clinical therapeutic strategies. Methods  Retrospectively analyze the clinical and pathological data of 292 patients with non-metastatic T4 colon cancer, who underwent colectomy at the First Affiliated Hospital of Naval Medical University from January 1, 2015, to December 31, 2021. Cox regression was used to analyze factors affecting peritoneal metastasis within 2 years after surgery. Results    The univariate analysis showed that BMI≥30 and BMI ranging from 25 to 30, postoperative pathological N-stage, tumor deposits status, embolism of vascular cancer, BRAF genotype, and surgical method were associated with peritoneal metastasis within 2 years after surgery (P<0.05). The multivariate analysis showed that BMI≥30 (HR=4.881, 95%CI 1.272-18.735, P=0.021), BMI ranging from 25.0 to 30 (HR=3.040, 95%CI 1.286-7.184, P=0.011), and positive embolism of vascular cancer (HR=4.105, 95%CI 1.830-9.210, P=0.001) were independent risk factors for peritoneal metastases within 2 years after surgery. Positive tumor deposits (HR=2.135, 95%CI 0.995-4.586, P=0.052) and laparoscopic surgical approach (HR=2.061, 95%CI 0.951-4.460, P=0.067) were potential independent risk factors for peritoneal metastasis within 2 years after surgery. Conclusion    The laparoscopic surgical approach should be carefully selected for patients with non-metastatic T4 stage colon cancer. For non-metastatic T4 colon cancer patients with BMI≥25, positive embolism of vascular cancer, or  positive tumor deposits, regular postoperative  and close monitoring for peritoneal metastases should be applied for early treatment and improved prognosis.

Key words: T4 colon cancer, laparoscopy, peritoneal metastases, colectomy, influencing factors