影响大肠癌肝转移的多因素回归分析

发布时间：2018-06-10 14:06

  本文选题：大肠癌肝转移 + 影响因素　； 参考：《湖北中医药大学》2017年硕士论文

【摘要】：目的 通过对曾在湖北省中医院肿瘤科住院及门诊治疗的54例大肠癌根治术后患者进行临床研究,运用统计学方法归纳探讨年龄、性别、中医证型、治疗方式等多个方面与这些患者术后肝转移之间是否存在统计学差异。对影响大肠癌肝转移的部分可能因素进行探讨研究,为中西医结合预防及治疗大肠癌肝转移提供理论依据,尤其是中医药在防治肝转移上的作用,以期将来在临床上能合理运用中西医结合治疗方法达到延缓甚至防止大肠癌肝转移的目的。方法 本研究采用回顾性分析方法,根据制定的相关纳入及排除标准筛选出的2015年1月-2017年1月在湖北省中医院花园山及光谷院区肿瘤科病房住院及门诊治疗的原发性大肠癌术后患者54例,运用X2检验及Logistic回归分析,统计分析及归纳可能影响大肠癌肝转移的多项相关因素。结果 54例患者中已出现肝转移的34例,未出现的肝转移患者20例。男性24人,占比44.4%,女性30人,占比55.6%。先行单因素分析:(1)所有患者,年龄最大的有75岁,最小的有29岁,分为60岁组和≥60岁组,其中60岁组共29人,14人出现肝转移,占比48.3%,15人未见肝转移,≥60岁组共25人,20人肝转移,占比80%,5人未见肝转移,两组比较具有统计学差异(P0.05),年龄可能是影响肝转移的因素之一,年长的病人相较年轻人更易出现肝转移。(2)按肿瘤原发部位分为结肠组和直肠组,原发于结肠的29人,原发于直肠的25人。根据X2检验统计得出,两组无明显统计学差异,大肠癌肝转移与否与肿瘤原发部位无关。根据大肠癌手术同时有无淋巴结转移,可分为淋巴结转移组及无淋巴结转移组,有淋巴结转移的患者39人(72.2%)所占比例明显大于无淋巴结转移患者15人(27.8%),可能因为多数病人发现肿瘤时已发生淋巴结转移,且与肝转移之间具有统计学差异(P0.05),表明手术同时即发现有淋巴结转移是导致大肠癌肝转移的不利因素。(3)大肠癌肝转移与否与原发肿瘤的病理学分型有统计学差异(p0.05),本文研究所分的四种病理学分型中属于低及未分化腺癌肝转移人数最多,13人,占38.2%,表明组织分型为低及未分化腺癌的患者最易发生肝转移。(4)术前肿瘤标志物水平也与大肠癌肝转移相关,与大肠癌相关的肿瘤标志物cea、afp和ca-199中,cea及ca-199术前升高可能导致大肠癌肝转移,apf统计学无明显意义。(5)中医证型区别也与大肠癌肝转移相关(p0.05),脾肾两虚证发生肝转移概率最大(47%),且具有统计学意义(p0.05);肝脾不和证也是较易导致肝转移发生的证型(38.2%),与其他证型比较具有统计学意义(p0.05);肝肾阴虚证(11.8%),与大肠癌肝转移关系不大(p0.05),湿浊内蕴证(2.9%),导致肝转移几率最低。(6)在治疗方式上,未完成或未行术后辅助化疗的患者肝转移率较高(70.6%)及未服用或不规律服用中药的患者肝转移人数相较非肝转移者多,占比(91.7%),均具有统计学差异(p0.05),规律服用中药的人中服药长达1年的患者肝转移率较低(21.7%),具有统计学差异(p0.05)。(7)在本文中讨论的因素中患者性别和肿瘤原发部位与大肠癌肝转移与否无明显相关性,根据肝转移与非肝转移之间的比较统计显示这两组均无统计学差异(p0.05)。运用logistic回归分析对单因素分析中具有统计学意义的几项因素再行多因素分析,结果表明年龄、淋巴结、化疗完成情况、中药服药时间及术前cea水平为影响大肠癌肝转移的独立影响因素(p0.05),其中年龄、淋巴结和术前cea水平的or值1,表明这三个指标为导致大肠癌肝转移的危险因素。化疗完成情况及服用中药时间or值1,表明完成化疗的患者肝转移几率较低,中药服用时间越长肝转移可能性越小。结论 通过对文中10个因素的单因素及多因素分析,得出年龄、肿瘤的组织分型、术前cea及ca-199水平、手术时是否有淋巴结转移、化疗完成情况、中医证型及中药的治疗时间都与结直肠癌肝转移相关。年龄大于60岁易发生肝转移;低及未分化腺癌是最易导致肝转移的肿瘤病理类型;术前cea及ca-199有升高易导致肝转移的发生;中医证型中脾肾两虚证最易发生肝转移,肝脾不和证也有导致肝转移的可能;未能或未行术后辅助化疗或未规律服用中药的患者易发生肝转移,由此可见不规范的治疗方式和不到位的治疗会增加复发和转移的危险性。按照NCCN指南的标准治疗方案治疗及长期中药调理能降低结直肠癌肝转移几率,是防治肝转移的有利因素。临床上应对这几类危险因素引起重视,加以定期监测及有效地预防治疗。对于有效地治疗方案也应积极劝导病人配合治疗,以此来降低大肠癌肝转移的发生率。
[Abstract]:Objective through the clinical study of 54 patients after radical resection of colorectal cancer who were hospitalized in the oncology department of Hubei Provincial Traditional Chinese Medical Hospital and the outpatient clinic, statistical methods were used to investigate whether there were statistical differences between the patients' age, sex, TCM syndrome type and treatment methods and the postoperative liver metastases of these patients. In order to prevent and treat the liver metastasis of colorectal cancer, this study provides a theoretical basis for the combination of traditional Chinese and Western medicine to prevent and treat the liver metastasis of colorectal cancer, especially the role of traditional Chinese medicine in the prevention and treatment of liver metastasis. 54 cases of primary colorectal cancer treated in January -2017 January 2015, Hubei Provincial Traditional Chinese Medical Hospital, Optics Valley and the oncology ward of Hubei Provincial Traditional Chinese Medical Hospital, Hubei Provincial Traditional Chinese Medical Hospital were selected by retrospective analysis. The statistical analysis and induction could affect the large intestine by X2 test and Logistic return analysis. Results in 54 cases, there were 34 cases of liver metastases, 20 cases of liver metastases, 24 men, 44.4% and 30 women, accounting for 55.6%. single factor analysis: (1) all patients were 75 years old, and the youngest was 29 years old, divided into 60 years and 60 years of age, among which 60 group 29, 14, etc. People had liver metastasis, accounted for 48.3%, 15 people had no liver metastasis, more than 60 years old 25 people, 20 liver metastases, 80%, 5 people did not have liver metastases, two groups have statistical difference (P0.05), age may be one of the factors affecting liver metastasis, older patients are more prone to liver metastasis than young people. (2) the primary site of the tumor is divided into colon group and the primary site of the tumor. The rectal group, 29 of the primary colon and 25 people in the rectum, was found in the rectum. According to the X2 test statistics, there was no significant difference between the two groups. The metastasis of colorectal cancer was not related to the primary site of the tumor. According to the operation of colorectal cancer, lymph node metastasis was also divided into lymph node metastasis group and no lymph node metastasis group, and 39 patients with lymph node metastasis were found. The proportion of people (72.2%) was significantly greater than that of 15 patients without lymph node metastasis (27.8%). It may be because most patients found lymph node metastasis when they found tumor, and there was a statistical difference from liver metastasis (P0.05). It was found that lymph node metastasis was an unfavorable factor in the liver metastasis of colorectal cancer. (3) liver metastasis of colorectal cancer. There was a statistically significant difference in the pathological type of primary tumor (P0.05). In this study, the number of liver metastases of low and undifferentiated adenocarcinoma was the most in the four types of pathological classification, and 13 people, accounting for 38.2%. (4) the level of tumor markers in the patients with low and undifferentiated adenocarcinoma was the most likely to occur. (4) the level of preoperative tumor markers was also associated with the liver metastasis of colorectal cancer. Related to colorectal cancer related tumor markers CEA, AFP and CA-199, the elevation of CEA and CA-199 may lead to liver metastasis of colorectal cancer, and APF statistics have no significant significance. (5) the difference of TCM syndrome type is also associated with liver metastasis of colorectal cancer (P0.05), the largest probability of liver metastasis in the two deficiency syndrome of spleen and kidney (47%), and statistically significant (P0.05); liver splenic disharmony Syndrome is also more likely to lead to the occurrence of liver metastasis (38.2%), compared with other syndrome types (P0.05); liver kidney yin deficiency syndrome (11.8%), and liver metastasis of large intestine cancer (P0.05), damp turbidity syndrome (2.9%), and the lowest risk of liver metastasis. (6) in the treatment, patients who have not completed or did not perform postoperative adjuvant chemotherapy The number of liver metastases in patients with high (70.6%) and non taking or irregular use of traditional Chinese medicine was more than those of non liver metastases (91.7%), and had statistical differences (P0.05). The rate of liver metastasis was lower (21.7%) in the patients who took traditional Chinese medicine for 1 years (21.7%), and (7) in the factors discussed in this article, the sex and swelling of the patients were discussed. There was no significant correlation between the primary site of the tumor and the liver metastasis of colorectal cancer. According to the comparison of liver metastases and non hepatic metastases, there was no statistical difference between the two groups (P0.05). Multiple factors were analyzed by logistic regression analysis on several factors of statistical significance in single factor analysis. The results showed that age, lymph nodes, chemotherapy were finished. The time of taking medicine and the level of CEA before operation were the independent factors affecting the liver metastasis of colorectal cancer (P0.05), of which the or value of age, lymph node and preoperative CEA level was 1, indicating that these three indexes were the risk factors leading to the liver metastasis of colorectal cancer. The completion of chemotherapy and the or value of traditional Chinese medicine were 1, indicating the liver metastasis of patients undergoing chemotherapy. The probability is low, the longer the possibility of the longer Chinese medicine, the less possibility of liver metastasis. Conclusion through the analysis of the single factor and multiple factors of the 10 factors in the article, the age, the histological classification of the tumor, the level of CEA and CA-199 before operation, the lymph node metastasis, the completion of chemotherapy, the treatment time of Chinese medicine and Chinese medicine are all with the liver transfer of colorectal cancer. Shift related. Liver metastasis is easy to occur at age 60 years of age; low and undifferentiated adenocarcinoma is the most likely pathological type of liver metastases; CEA and CA-199 before operation may lead to liver metastasis; the spleen and kidney of TCM syndrome is the most likely to occur liver metastasis, liver and spleen syndrome also may lead to liver metastasis; no or no postoperative adjuvant chemotherapy Patients with or without regular use of traditional Chinese medicine are prone to liver metastasis. This shows that nonstandard treatment and poor treatment will increase the risk of recurrence and metastasis. The standard treatment plan treatment and long-term Chinese medicine conditioning according to the NCCN guide can reduce the risk of liver metastasis in colorectal cancer. It is a favorable factor in the prevention and treatment of liver metastasis. Several types of risk factors are paid attention to, regular monitoring and effective prevention and treatment. For effective treatment programs, patients should also be actively persuaded to cooperate with treatment in order to reduce the incidence of liver metastasis in colorectal cancer.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.34
，

本文编号：2003479