摘要
目的探讨直肠癌异时性肺转移无病间期（DFI）长短的相关影响因素。方法回顾性分析2001年1月至2013年12月间上海第二军医大学附属长海医院肛肠外科收治的92例直肠癌异时性肺转移患者的临床资料，分别采用Log，rank检验和Cox比例风险模型，对性别、年龄、肿瘤远端距齿状线距离、术前血清CEA水平、肿瘤组织学类型、肿瘤T分期、N分期、术前新辅助放疗和术后辅助化疗等可能影响术后异时性肺转移DFI时间长短的临床病理特征，进行单因素和多因素分析。结果92例患者中男性59例，女性33例，中位年龄61（26—81）岁。肿瘤远端距齿状线距离〈5cm者36例；术前血清CEA水平≥5μg／L者44例；腺癌69例，黏液腺癌23例；肿瘤T1-2期19例，L3-4期73例；N0期43例，N1-2期49例；有30患者术前接受了新辅助放疗；有63例患者术后接受了辅助化疗。全组中位随访时间为62（3—140）月，总DFI为（25．9±21．0）5。单因素分析显示，肿瘤远端距齿状线距离（χ2=4．496，P=0．034）、术前血清CEA水平（χ2=5．553，P：0．018）、肿瘤T分期（χ2=5．796，P=0．016）和N分期（χ2=6．780，P=0．009）、术前新辅助放疗（χ2=11．718，P=0．001）和术后辅助化疗（χ2=9．214，P=0．002）是影响直肠癌异时性肺转移DFI时间长短的因素。肿瘤远端距齿状线距离〈5cm、术前血清CEA水平≥5μg／L、肿瘤T3-4期和N1-2期、术前未接受新辅助放疗以及术后接受辅助化疗的患者，直肠癌异时眭肺转移DF[更短。Cox多因素分析显示，肿瘤远端距齿状线距离（OR=1．770，95％CI：1．115～2．812，P=0，016）、N分期（OR=0．525，95％C1：0．309～0．891，P=0．017）以及术前新辅助放疗（OR=1．976，95％CI：1．228～3．401，P=0．006）是影响直肠癌异时性肺转移DFI时间缩短的独立危险因素。结论肿瘤远端距离齿状线距离近、N分期晚以及术前未行新辅助放疗的直肠癌患者，术后短期内更容易发生异时性肺转移。
Objective To investigate the factors in the disease-free interval （DFI） of metachronous pulmonary metastasis from rectal cancer. Methods Clinical data of 92 patients with metachronous pulmonary metastasis from rectal cancer in the Department of Colorectal Surgery at the Changhai Hospital of the Second Military Medical University from January 2001 to December 2013 were analyzed retrospectively. Univariate and multivariate analysis were performed to find the factors affecting disease-free interval of metachronous pulmonary metastasis from rectal eaneer using Log-rank test and Cox proportional hazards model, respectively. Results The median age of all the eases was 61 （range, 26-81 ） years. Of the 92 eases, 59 were males and 33 were females. Thirty-six eases were confirmed to have 〈 5 cm distance from lower margin to dentate line. Forty-four cases were examined to have 5 Izg/L earcinoembryonie antigen （CEA） level. Of these eases reviewed pathologically, 69 eases were adenocarcinoma, 23 were mucinous adenocarcinoma; 19 cases had stage T1-2 lesions, 73 had stage T3-4 lesions; 43 cases had stage NO metastasis, 49 had stage N1-2 metastasis. Thirty cases received preoperative radiotherapy, 63 cases received postoperative chemotherapy. The median follow up time of all the cases was 62 （range, 3-140） months. The DFI of all the cases was （25.9 ±21.0） months. Univariate Log-rank test indicated that the factors associated with the disease-free interval of metachronous pulmonary metastasis of rectal cancer were location of the tumor （χ2 = 4.496, P = 0.034）, preoperative CEA level （χ2 = 5.553, P= 0.018）, T stage （χ2= 5.796, P= 0.016）, N stage （ χ2= 6.780, P = 0.009）, preoperative neoadjuvant radiotherapy（χ2 = 11.718, P = 0.001 ） and postoperative adjuvant chemotherapy （χ2 = 9.214, P = 0.002）. A shorter distance from lower margin to dentate line（〈 5 era）, a lower preoperative CEA level （〈 5 μg/L）, advanced T stage lesions （T3-4）, advanced N stage metastasis （N1-2）, no use of preoperative radiotherapy and use of postoperative chemotherapy were associated with shorter DFI of patients with metachronous pulmonary metastasis from rectal cancer. Multivariate analysis showed that N stage（OR = 0.525, 95% CI： 0.309 - 0.891, P = 0.017）, location of the tumor （OR = 1.770, 95% C1：1.115 - 2.812, P= 0.016） and preoperative neoadjuvant radiotherapy （OR = 1.976, 95% CI： 1.228 - 3.401, P = 0.006） were the independent risk factors associated with the disease-free interval of metachronous pulmonary metastasis from rectal cancer. Conclusions Advanced N stage, low location of the tumor and no use of preoperative neoadjuvant radiotherapy are risk factors of shorter disease-free interval of metachronous pulmonary metastasis from rectal cancer.
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2016年第5期562-565,共4页
Chinese Journal of Gastrointestinal Surgery
关键词
直肠肿瘤
肺转移
影响因素
无病间期
Rectal neoplasms
Metachronous pulmonary metastasis
Associated factors
Disease-free interval
