关键词: 结直肠肿瘤, 癌结节, 肝转移, 外科学, 病理学

Abstract:

Objective To investigate the effect of cancer nodules on postoperative liver metastasis in patients undergoing radical resection of colorectal cancer. Methods The clinicopathological data of 196 patients undergoing radical operation for colorectal cancer admitted to the Dongnan Hospital of Xiamen University from January 2019 to June 2020 were retrospectively analyzed. According to the pathological results， they were divided into cancer nodule group and non-cancer nodule group. Time and the number of liver metastasis during the follow-up period were analyzed. The relationship between cancer nodules and clinicopathological features was analyzed， and the influencing factors of postoperative liver metastasis in patients with colorectal cancer were analyzed by univariate and logistic multivaiate analysis. The receiver operator characteristic （ROC） curve was drawn to analyze the predictive effect of cancer nodule diameter on postoperative liver metastasis of colorectal cancer. Results There were 50 patients accompanied by cancer nodules in 196 patients with colorectal cancer， the incidence rate was 25.5%， the diameter of cancer nodules was 0.4-1.8 cm， the median diameter was 1.0 cm， and there were 46 patients with liver metastasis， the incidence rate was 23.5%. There were statistically significant differences in carbohydrate antigen CA19-9 （χ²=7.55， P=0.006）， maximum tumor diameter （χ²=12.23， P<0.001）， T stage （χ²=15.79， P<0.001）， vascular thrombus （χ²=12.79， P<0.001）， lymph node metastasis （χ²=16.18， P<0.001） between the cancer nodule group and the non-cancer nodule group. Univariate analysis showed that CA19-9 （χ²=7.40， P=0.007）， maximum tumor diameter （χ²=8.23， P=0.004）， T stage （χ²=4.58， P=0.032）， vascular cancer thrombus （χ²=12.97， P<0.001）， lymph node metastasis （χ²=3.96， P=0.047）， cancer nodules （χ²=67.60， P<0.001）， cancer nodule diameter （t=4.28， P<0.001）， and the number of cancer nodules （χ²=68.77， P<0.001） were all influential factors for postoperative liver metastasis in colorectal cancer patients. Multivariate analysis showed that stage T_3-4 （OR=4.62， 95%CI： 1.51-7.35， P=0.003）， vascular cancer thrombus （OR=5.42， 95%CI：1.75-12.85， P<0.001）， accompanied by cancer nodules （OR=18.54， 95%CI： 7.45-39.73， P<0.001）， the diameter of cancer nodules （OR=13.20， 95%CI： 4.74-29.64， P<0.001）， number of nodules [one cancer nodule （OR=9.11， 95%CI： 2.24-27.34， P<0.001）， two cancer nodules （OR=6.36， 95%CI： 1.38-9.08， P<0.001） and three cancer nodules （OR=5.00， 95%CI： 1.98-8.84， P<0.001）] were independent influencing factors for postoperative liver metastasis in patients with colorectal cancer. ROC curve analysis showed that the best threshold of the diameter of cancer nodules for predicting liver metastasis was 1.1 cm [area under the curve （AUC）=0.764， 95%CI： 0.632-0.896， P=0.002）. The incidence of liver metastasis in patients with cancer nodules diameter≥1.1 cm was 95.65%（22/23）， higher than that in patients with cancer nodules diameter<1.1 cm （40.74%，11/27）， with a statistically significant difference （χ²=16.69， P<0.001）. Conclusion Patients with colorectal cancer with cancer nodules≥1.1 cm in diameter should be vigilant against postoperative liver metastasis.

Key words: Colorectal neoplasms, Cancer nodules, Liver metastasis, Surgery, Pathology