中国实用外科杂志2025，Vol.45Issue(2)：202-207,6.DOI:10.19538/j.cjps.issn1005-2208.2025.02.13
Ⅲc期结直肠癌根治术后复发转移的危险因素分析
Analysis of risk factors for recurrence and metastasis after radical surgery for stage Ⅲc colorectal cancer
摘要
Abstract
Objective To analyze the risk factors for recurrence and metastasis after radical surgery for stage Ⅲ c 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 Ⅲ c 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(x2=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(x2=1 1.234,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(x2=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.关键词
结直肠癌/Ⅲ期/转移淋巴结比例/根部淋巴结转移/CEAKey words
colorectal cancer/stage Ⅲ/proportion of metastatic lymph nodes/root lymph node metastasis/carcinoem-bryonic antigen分类
医药卫生引用本文复制引用
许东,谢逸林,路慧欣,程坦坦,卢传辉,苏国强,黎凡..Ⅲc期结直肠癌根治术后复发转移的危险因素分析[J].中国实用外科杂志,2025,45(2):202-207,6.基金项目
国家自然科学基金项目(No.81970462) （No.81970462）
厦门市医疗卫生重点项目(No.3502Z20204001) National Natural Science Foundation of China(No.81970462) （No.3502Z20204001）
Xiamen Municipal Key Medical and Health Project(No.3502Z20204001) （No.3502Z20204001）
