结直肠癌肝转移的临床因素分析

发布时间：2018-03-11 09:49

本文选题：结直肠癌　切入点：肝转移　出处：《吉林大学》2010年硕士论文　论文类型：学位论文

【摘要】： 目的:探讨结直肠癌患者临床、病理特点与肝转移的关系。方法:回顾性分析了吉林大学中日联谊医院2006年1月-2009年12月收治的资料完整的术后病理证实的结直肠癌住院患者305例,就性别、病程、年龄、肿瘤发生部位、分化程度、浸润深度、有无肝炎病史、有无淋巴结转移、有无腹膜及大网膜转移结节等方面对有无肝转移进行对比分析。结果:结直肠癌有无肝转移患者的性别、肿瘤发生部位及是否感染乙肝病毒等方面相比均无统计学差异。肿瘤发展病程与结直肠癌肝转移有关,病程1年以上组的肝转移率(67.31%)明显高于1年以内组(25.30%),两者间有显著的统计学差异(P0.01)。结直肠癌患者的年龄与肝转移有关,青年组较中老年组易发生肝转移,青、中、老年组肝转移率分别为61.54%、32.17%、30.20%。青年组与中、老年组相比有统计学意义(P0.05),中、老年组相比则无统计学意义(P0.05)。肿瘤细胞的分化程度与结直肠癌的肝转移密切相关,低分化者易出现肝转移。低、中、高分化组的肝转移率分别为57.58%、20.86%、15.79%,低分化组与中、高分化组间有显著的统计学意义(P0.01),而中、高分化组间无统计学差异(P0.05)。肿瘤侵犯肠壁越深,肝转移机率越高,肿瘤浸润全层及全层以外者肝转移率(39.74%)明显高于浸润肌层以内者(10.53%),两者相比有显著的统计学差异(P0.01)。有区域淋巴结转移的结直肠癌患者易发生肝转移,且随着淋巴结转移数目的增加,肝转移发生率亦增加,区域淋巴结转移0枚、1~3枚、4枚或4枚以上组肝转移率分别为21.93%、42.11%、61.90%,差异有显著统计学意义(P0.01)。结直肠癌肝转移与腹膜、大网膜转移结节密切相关,有腹膜、大网膜转移结节组肝转移率(75.76%)明显高于无转移结节组(27.21%),两组相比有显著统计学差异(P0.01)。将单因素分析中有统计学意义的6项(年龄、病程、分化程度、浸润深度、淋巴结转移、腹膜及大网膜转移)行Cox多因素回归分析,结果示肿瘤分化程度、浸润深度、淋巴结转移、腹膜及大网膜转移结节与肝转移有关,排除了年龄、病程因素的影响。结论:结直肠癌的肝转移与患者性别、肿瘤发生部位及是否感染乙肝病毒无关;病程1年以上、年龄小于等于35岁、病理为低分化、肿瘤浸润肠壁全层及全层以外、有区域淋巴结转移及有腹膜、大网膜转移结节者易出现肝转移。
[Abstract]:Objective: to investigate the relationship between clinical, pathological features and liver metastasis in patients with colorectal cancer. Methods: a total of 305 patients with colorectal cancer admitted from January 2006 to December 2009 in the Sino-Japanese Friendship Hospital of Jilin University were retrospectively analyzed according to sex, course of disease, age, location of tumor occurrence and degree of differentiation. The depth of infiltration, history of hepatitis, lymph node metastasis, peritoneal and omentum metastasis were compared. Results: there was no significant difference in sex, tumor location and hepatitis B virus infection in patients with colorectal cancer with or without liver metastasis. The course of tumor development was related to liver metastasis of colorectal cancer. The rate of liver metastasis in the group of disease course more than one year (67.31%) was significantly higher than that in the group of less than one year (25.30%). There was a significant difference between the two groups (P 0.01). The age of colorectal cancer patients was related to liver metastasis, and the young group was more likely to have liver metastasis than the middle and old group. The liver metastasis rates in the elderly group were 61.54 and 32.170.20.The difference between the young group and the middle age group was statistically significant (P 0.05), but there was no significant difference in the middle and old group. The differentiation of tumor cells was closely related to the liver metastasis of colorectal cancer. The liver metastasis rates of low, middle and high differentiation groups were 57.58 and 20.86 ~ 15.79, respectively. There was significant statistical significance between low differentiation group, middle differentiation group and high differentiation group, but there was no statistical difference between middle and high differentiation group (P 0.05). The higher the probability of liver metastasis was, the higher the liver metastasis rate was (39.74%) in patients with tumor invasion in the whole layer and outside the whole layer) than in those within the infiltrating muscular layer (10.53%). There was significant statistical difference between the two groups (P < 0.01). The patients with regional lymph node metastasis were more likely to have liver metastasis. With the increase of the number of lymph node metastasis, the incidence of liver metastasis also increased. The liver metastasis rate in the group of 0 regional lymph node metastasis, 3 or more were 21.9333.11 and 61.90, respectively. The difference was statistically significant (P 0.01). The liver metastasis and peritoneal membrane of colorectal cancer were significantly different. The liver metastasis rate in the group with greater omentum metastasis was significantly higher than that in the group without metastatic node (P 0.01), and there was a significant difference between the two groups (P 0.01). In univariate analysis, 6 items (age, course of disease) were significantly higher than those in the group without metastasis of greater omentum, and the rate of hepatic metastasis was significantly higher in the group with greater omentum metastasis than that in the group without metastasis of greater omentum. Cox regression analysis showed that the degree of differentiation, depth of invasion, lymph node metastasis, peritoneal and omentum metastasis were related to liver metastasis. The influence of age and course of disease was excluded. Conclusion: the liver metastasis of colorectal cancer is not related to sex, location of tumor and infection of hepatitis B virus, the course of disease is more than one year, the age is less than 35 years old, the pathology is low differentiation, the tumor infiltrates the whole layer and the whole layer of intestinal wall. Regional lymph node metastasis and peritoneal lymph node metastasis, greater omentum metastasis nodules prone to liver metastasis.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R735.3

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