| 摘要: |
| 目的 探讨影响结直肠癌根治术后5年内脑转移的危险因素。方法 回顾性分析2003年1月至2011年12月间第二军医大学长海医院肛肠外科收治的1 104例结直肠癌患者的临床资料，其中30例（2.7%）术后出现脑转移。所有患者均行结直肠癌根治性切除术，其中直肠癌患者遵循全直肠系膜切除（total mesorectal excision，TME）原则。术后TME分期提示为Ⅱ期或更晚分期的患者，根据情况接受卡培他滨联合奥沙利铂方案（XELOX）或氟尿嘧啶联合奥沙利铂方案（FOLFOX）的化疗。分别采用χ2检验和logistic多因素分析模型，对性别、年龄、肿瘤位置、术前血清癌胚抗原（CEA）水平、肿瘤组织学类型、肿瘤浸润深度、是否有淋巴结转移、是否伴肺转移、是否伴肝转移等可能影响术后脑转移的临床病理特征进行单因素和多因素分析。结果 单因素分析显示，肿瘤位置（χ2=5.844，P=0.016）、术前血清CEA水平（χ2=5.395，P=0.020）、肿瘤组织学类型（χ2=4.950，P=0.026）和是否伴肺转移（χ2=52.569，P=0.000）是影响结直肠癌根治术后5年内脑转移的相关因素。Logistic多因素分析显示，肿瘤位置（OR=0.278，95%CI：0.095~0.817，P=0.020）、术前血清CEA水平（OR=0.423，95%CI：0.192~0.933，P=0.033）和是否伴肺转移（OR=10.814，95%CI：4.705~24.856，P=0.000）是影响结直肠癌根治术后5年内发生脑转移的独立危险因素。结论 肿瘤位置为直肠、高术前CEA水平及伴有肺转移的结直肠癌患者术后5年内更容易发生脑转移。 |
| 关键词: 结直肠肿瘤 脑转移 根治术 危险因素 |
| DOI：10.16781/j.0258-879x.2017.08.0993 |
| 投稿时间：2017-02-19修订日期：2017-06-24 |
| 基金项目: |
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| Risk factor analysis for brain metastasis after radical resection of colorectal cancer within 5 years |
| YANG Xiao-hong,LI Ang,FU Chuan-gang,YU En-da* |
(Department of Colorectal Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To explore the risk factors of brain metastasis after radical resection of colorectal cancer within 5 years. Methods We retrospectively analyzed the clinical data of 1 104 patients with colorectal cancer in the Department of Colorectal Surgery of Changhai Hospital of Second Military Medical University from Jan. 2003 to Dec. 2011. Thirty of 1 104 cases (2.7%) had brain metastasis. All patients received radical resection of colorectal cancer, and the rectal cancer patients followed the total mesorectal excision (TME) principle. According to the TME stage, the patients of stage Ⅱ or later were treated with capecitabine combined with oxaliplatin (XELOX) or fluorouracil plus oxaliplatin (FOLFOX) chemotherapy. The clinicopathological features that might affect post-operative brain metastasis, including gender, age, tumor location, pre-operative serum carcino-embryonic antigen (CEA) level, tumor histological type, depth of tumor invasion, lymph node metastasis, pulmonary metastases and liver metastases, were analyzed by univariate analysis using Chi square test. Multivariate analysis was performed to search for the independent risk factors of brain metastasis from colorectal cancer using logistic regression. Results Univariate Chi square test indicated that the relative factors associated with the brain metastasis of colorectal cancer within 5 years were tumor location (χ2=5.844, P=0.016), pre-operative CEA level (χ2=5.395, P=0.020), tumor histological type (χ2=4.950, P=0.026) and with pulmonary metastasis (χ2=52.569, P=0.000). Multivariate analysis showed that the tumor location (OR=0.278, 95%CI:0.095-0.817, P=0.020), pre-operative CEA level (OR=0.423, 95%CI:0.192-0.933, P=0.033) and with pulmonary metastasis (OR=10.814, 95%CI:4.705-24.856, P=0.000) were the independent risk factors of brain metastasis of colorectal cancer within 5 years. Conclusion Patients with rectal cancer, higher pre-operative CEA level and pulmonary metastasis have a high risk of brain metastasis of colorectal cancer within 5 years. |
| Key words: colorectal cancer brain metastasis radical resection risk factors |
