直肠癌术前临床分期及癌胚抗原预测术后复发与转移

谭安辉; 柯腾飞

doi:10.12259/j.issn.2095-610X.S20211217

直肠癌术前临床分期及癌胚抗原预测术后复发与转移

doi: 10.12259/j.issn.2095-610X.S20211217

谭安辉¹,
柯腾飞^2, ,

1.
恩施州中心医院中医部肛肠科，湖北恩施　445000
2.
云南省肿瘤医院放射科，云南昆明　650018

基金项目: 云南省科技厅科技计划基金资助项目（202001AY070001-072）

详细信息

作者简介:
谭安辉（1986～），男，湖北恩施人，医学学士，住院医师，主要从事直肠癌治疗及预后临床工作

通讯作者:
柯腾飞，E-mail：250169995@qq.com

中图分类号: R714.46
计量
- 文章访问数: 3355
- HTML全文浏览量: 2165
- PDF下载量: 28
- 被引次数: 0
出版历程
- 收稿日期: 2021-09-13
- 网络出版日期: 2021-11-17
- 刊出日期: 2021-12-15

Rectal Cancer Preoperative Clinical Staging and Postoperative Recurrence and Metastasis Prediction by Carcinoembryonic Antigen

An-hui TAN¹,
Teng-fei KE^{2
, ,}

1.
Dept. of Anorectal Medicine，The Traditional Chinese Medicine，Enshi Central Hospital，Enshi Hubei，445000
2.
Dept. of Radiology，Yunnan Cancer Hospital， Kunming Yunnan 650018，China

摘要

摘要: 目的探讨直肠癌患者术前临床分期及癌胚抗原与术后预后相关分析。方法收集恩施州中心医院2013年10月至2015年10月直肠癌患者200例；收集患者病理T、N、M分期、术前CEA值、病灶所在肠管位置、累及肠管长度（CT图像测量）、累及肠圈比例、肠周淋巴结是否阳性、环周切缘是否阳性、距离肛门距离、壁外血管是否受浸润，这几个指标为回顾性收集资料；随访观察患者术后是否发生复发和转移2个结果，并记录发生复发、转移、死亡时间。研究方法：用Cox多因素相关分析上述几个指标与患者术后发生复发、转移2个结果相关分析，并找到预测术后发生复发、转移的因素。总生存时间用Kaplan - Meier曲线描述复发和转移患者，并用Log-Rank检验其差异。结果与术后发生转移相关因素分别为N分期P = 0.001；HR = 11.22；95%CI（2.55，49.25）、术前CEA值P < 0.001，HR = 1.00；95%CI（1.002，1.006），这2个因素与术后发生远处转移有相关性；与术后发生局部复发相关的因素为T分期P = 0.036；；HR = 1.726；95%CI（1.03，2.87）、术前CEA值P = 0.034；HR = 1.00；95%CI（0.99，1.005）。结论 T分期与术后局部复发有显著相关，N分期与术后远处转移有相助相关性。术前T分期能预测直肠癌术后局部复发；术前N分期与CEA能预测直肠癌术后远处转移。
- 直肠癌 /
- Cox多因素风险回归 /
- 复发转移 /
- 癌胚抗原
Abstract: Objective To explore the correlation between preoperative clinical stage, carcinoembryonic antigen and postoperative prognosis in patients with rectal cancer. Methods 200 patients with rectal cancer from October 2013 to October 2015 were collected from The Central Hospital of Enshi Prefecture. Pathological T, N, AND M staging, preoperative CEA value, lesion location, length of involved bowel （measured by CT image）, proportion of involved bowel, positive periintestinal lymph nodes, positive circumferential resection margin, distance from anus, and infiltration of extraneous vessels were collected retrospectively. The patients were followed up to observe whether the patients had recurrence, metastasis and death after surgery, and the time of recurrence, metastasis and death was recorded. Cox multivariate correlation analysis was used to analyze the correlation between the above indicators and postoperative recurrence and metastasis, and to find the factors that predicted postoperative recurrence and metastasis. Recurrence and metastasis were described by Kaplan-Meier curve and their differences were tested by Log-Rank. Results The factors related to postoperative metastasis were N stage, P = 0.001; HR = 11.22; 95%CI （2.55, 49.25）, preoperative CEA value P < 0.001, HR = 1.00; 95%CI （1.002, 1.006）; and these two factors were associated with distant metastasis after surgery. The factors associated with local recurrence were T stage （P = 0.036）; HR = 1.726; 95%CI （1.03, 2.87）, preoperative CEA value P = 0.034; HR = 1.00; 95%CI （0.99, 1.005）. Conclusion T staging was significantly associated with postoperative local recurrence, and N staging was associated with postoperative distant metastasis. Preoperative T staging can predict postoperative local recurrence of rectal cancer. Preoperative N staging and CEA can predict postoperative distant metastasis of rectal cancer.
- Rectal cancer /
- Cox multivariate risk regression /
- Recurrence and metastasis /
- Carcinoembryonic antigen

HTML全文

图 1 直肠癌局部复发、远处转移生存曲线差异分析

a：为局部复发、远处转移、新辅助治疗患者生存曲线差异比较；b：为局部复发、远处转移生存曲线比较。

Figure 1. Difference analysis of survival curves of local recurrence and distant metastasis of rectal cancer

下载: 全尺寸图片幻灯片

表 1 基础变量统计描述[n（%）]

Table 1. Statistical description of basic variables [n（%）]

变量	计量资料中位数 ± 标准差和计数资料
性别
男性	136（68.00 ）
女性	64（32.00 ）
年龄[（$\bar x \pm s $）岁]	57.12 ± 12.06
T分期
T1	3（1.50 ）
T2	22（11.00 ）
T3	66（33.00 ）
T4	109（54.50 ）
N分期
N0	35（17.50 ）
N1	121（60.50 ）
N2	44（22.00 ）
手术方式
Dixon’s手术	132（66.00 ）
Miles’s手术	45（22.50 ）
Hartman’s手术	13（6.50 ）
经肛门局部切除	10（5.00 ）

下载: 导出CSV

表 2 局部复发多因素Cox分析

Table 2. Multivariate Cox analysis of local recurrence

变量	Exp（B）	95.0% CI for Exp（B）		P
变量	Exp（B）	Lower	Upper	P
远处转移	1.458	0.452	4.697	0.528
T分期	1.726	1.035	2.878	0.036^*
N分期	0.4	0.14	1.143	0.087
CEA	1	0.995	1.005	0.034^*
病灶位置	1.147	0.568	2.315	0.702
累及肠管长度	1.011	0.974	1.049	0.564
肠壁厚度	1.049	0.953	1.154	0.328
累及肠圈	0.976	0.799	1.192	0.809
肠周淋巴结	0.992	0.807	1.22	0.938
环周切缘阳性	0.935	0.359	2.436	0.890
距肛门距离	0.995	0.979	1.012	0.586
壁外血管受浸润	1.017	0.416	2.487	0.971
与患者手术后发生局部复发相关因素为T分期、术前CEA值。^*P < 0.05。

下载: 导出CSV

表 3 远处转移多因素Cox分析

Table 3. Multivariate Cox analysis of distant metastasis

变量	Exp（B）	95.0% CI for Exp（B）		P
变量	Exp（B）	Lower	Upper	P
T分期	1.250	0.712	2.194	0.437
N分期	11.226	2.559	49.250	0.001^*
CEA	1.004	1.002	1.006	0.000^*
病灶位置	2.138	0.966	4.731	0.061
累及肠管长度	0.971	0.918	1.026	0.288
肠壁厚度	0.963	0.857	1.083	0.529
累及肠圈	1.136	0.880	1.467	0.329
肠周淋巴结	0.990	0.796	1.231	0.929
环周切缘阳性	0.275	0.058	1.299	0.103
距肛门距离	0.998	0.980	1.015	0.787
壁外血管受浸润	1.964	0.676	5.703	0.215
与患者手术后发生局部复发相关因素为N分期、术前CEA值。^*P < 0.05。

下载: 导出CSV

参考文献(13)

[1]	Wasmuth H H,Faerden A E,Myklebust T Å,et al. Transanal total mesorectal excision for rectal cancer has been suspended in Norway[J]. Br J Surg,2020,107(1):121-130.
[2]	Akce M,El-Rayes B F. Nonsurgical management of rectal cancer[J]. Oncol Pract,2019,15(3):123-131. doi: 10.1200/JOP.18.00769
[3]	Van Gijn W,Marijnen C A,Nagtegaal I D,et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer:12-year follow-up of the multicentre,randomised controlled TME trial[J]. Lancet Oncol,2011,12(6):575-582. doi: 10.1016/S1470-2045(11)70097-3
[4]	Fernandez L M,São Julião G P,Figueiredo N L,et al. Conditional recurrence-free survival of clinical complete responders managed by watch and wait after neoadjuvant chemoradiotherapy for rectal cancer in the International Watch & Wait Database:A retrospective,international,multicentre registry study[J]. Lancet Oncol,2021,22(1):43-50. doi: 10.1016/S1470-2045(20)30557-X
[5]	Alonso S,Pascual M,Salvans S,et al. Postoperative intra-abdominal infection and colorectal cancer recurrence:A prospective matched cohort study of inflammatory and angiogenic responses as mechanisms involved in this association[J]. Eur Surg Oncol,2015,41(2):208-214. doi: 10.1016/j.ejso.2014.10.052
[6]	Van Oostendorp S E,Belgers H J E,Hol J C,et al. The learning curve of transanal total mesorectal excision for rectal cancer is associated with local recurrence:Results from a multicentre external audit[J]. Colorectal Dis,2021,23(8):2020-2029. doi: 10.1111/codi.15722
[7]	刘启志, 郝立强, 楼征, 等结直肠癌术后早期和晚期复发转移与临床病理特征的关系[J]. 中华普通外科杂志, 2019, 34（8）: 675-678.
[8]	Lacy A M,Nogueira S T,Lacy F. Comment on:Norwegian moratorium on transanal total mesorectal excision[J]. British Journal Surgery,2019,106(13):1855-1855.
[9]	蒲竞,陈晓红,王慧春,等. 血清CEA、CA19-9及PET-CT SUV值对结直肠癌患者术后复发/转移的诊断价值[J]. 中国肛肠病杂志,2019,39(8):1-4. doi: 10.3969/j.issn.1000-1174.2019.08.001
[10]	Achilli P,Radtke TS,Lovely J K,et al. Preoperative predictive risk to cancer quality in robotic rectal cancer surgery[J]. Eur Surg Onco,2021,47(2):317-322. doi: 10.1016/j.ejso.2020.08.019
[11]	São Julião G P,Habr-Gama A,Vailati B B,et al. New strategies in rectal Cancer[J]. Surg Clin North Am,2017,97(3):587-604. doi: 10.1016/j.suc.2017.01.008
[12]	Walters S,Benitez Majano S,Muller P,et al. Is England closing theinternational gap in cancer survival?[J]. Br Cancer,2015,113(5):848-860. doi: 10.1038/bjc.2015.265
[13]	Benitez Majano S,Di Girolamo C,Rachet B,et al. Surgical treatment andsurvival from colorectal cancer in Denmark,England,Norway,and Sweden:A population-based study[J]. Lancet Onco ,2019,20(1):74-87. doi: 10.1016/S1470-2045(18)30646-6

相关文章(20)

[1]	杨镜玉, 许宁, 张雨涛, 黄凤昌, 蒋元明, 殷亮. 基于基线T2WI图对进展期直肠癌经放化同期治疗后病理完全缓解的多模型预测比较, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20230512
[2]	苟海梅, 方莉, 钟晓武. KRAS、NRAS及BRAF基因突变与结直肠癌肝转移的关系, 昆明医科大学学报. doi: 10.12259/j.issn.2095-610X.S20230106
[3]	杨宏军, 王晓斌, 孙相华, 李治纲. 冷循环射频消融治疗88例结直肠癌肝转移临床疗效, 昆明医科大学学报.
[4]	陈东, 陈海涛, 李支尧, 唐诗聪, 钏志睿, 张映贤, 罗晓茂. 直肠腔内360°超声和腔内矢状面超声在全段直肠癌术前TN分期和环周切缘中的应用价值, 昆明医科大学学报.
[5]	张智显, 顾后, 林劼, 雷学芬, 江利锋, 李楠, 路欣妍. 阿帕替尼联合雷替曲塞治疗常规治疗失败的结直肠癌肝转移的疗效, 昆明医科大学学报.
[6]	杨锡运, 付敏烽, 张永广, 魏东. 腹腔镜直肠癌根治术与开腹手术临床安全性的对比, 昆明医科大学学报.
[7]	杨雪君. 能谱曲线与常规形态学方法对结直肠癌转移淋巴结诊断准确性的对比, 昆明医科大学学报.
[8]	张升宁. 联合肝脏离断和门静脉结扎的二步肝切除治疗结直肠癌肝转移, 昆明医科大学学报.
[9]	张磊. 287例直肠癌术后预后因素的回顾性分析, 昆明医科大学学报.
[10]	栗明. 腹腔镜直肠癌根治术与传统开腹直肠癌手术的疗效对比, 昆明医科大学学报.
[11]	钟林. ATBF1在结直肠癌中的表达及其与转移相关性研究, 昆明医科大学学报.
[12]	艾毅钦. CT及MRI在直肠癌术前局部分期的临床诊断价值, 昆明医科大学学报.
[13]	姜凤元. 低位直肠癌96例临床治疗分析, 昆明医科大学学报.
[14]	任朝凤. 血清中多项联合检测在肺癌诊断中的临床意义, 昆明医科大学学报.
[15]	张鹤鸣. 超声内镜在直肠癌术前分期的诊断价值, 昆明医科大学学报.
[16]	殷亮. 结直肠癌治疗进展, 昆明医科大学学报.
[17]	. 两种血液稀释方法对直肠癌患者围术期T淋巴细胞亚群的影响, 昆明医科大学学报.
[18]	. 老年直肠癌患者运用小切口开腹手术的机体应激反应, 昆明医科大学学报.
[19]	肖仲贤. 无腹壁切口腹腔镜直肠癌前切除术1例报道, 昆明医科大学学报.
[20]	. 腹腔镜直肠癌手术20例临床体会, 昆明医科大学学报.