中国实用外科杂志2024，Vol.44Issue(7)：793-797,5.DOI:10.19538/j.cjps.issn1005-2208.2024.07.15
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
Study on the prediction model of lymph node metastasis and surgical strategy after non-curative endoscopic resection for locally early colorectal cancer
摘要
Abstract
Objective 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.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Key words
locally early colorectal cancer/endoscope/non-curative resection/additional surgery/lymph node metastasis分类
临床医学引用本文复制引用
赵富强,李吉云,张明光,梅世文,赵巍,黄飞,肖体先,郑朝旭,刘骞..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[J].中国实用外科杂志,2024,44(7):793-797,5.基金项目
国家重点研发计划项目(No.2022YFC2505003) （No.2022YFC2505003）
中国医学科学院医学与健康科技创新工程项目(No.2022-12M-C&T-B-057) （No.2022-12M-C&T-B-057）
