Effect of cancer nodules on liver metastases after radical resection of colorectal cancer

doi:10.3760/cma.j.cn371439-20231017-00047

Abstract

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

Wang Junyi, Hong Kaibin, Ji Rongjia, Chen Dachao. Effect of cancer nodules on liver metastases after radical resection of colorectal cancer[J]. Journal of International Oncology, 2024, 51(5): 280-285.

Figures/Tables 4

References 25

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临床病理特征	癌结节组（n=50）	无癌结节组（n=146）	t/χ²值	P值	临床病理特征	癌结节组（n=50）	无癌结节组（n=146）	t/χ²值	P值
年龄（岁）	59.60±5.49	60.04±4.80	-0.55	0.585	肿瘤最大长径（cm）
性别					≥5	23	30	12.23	<0.001
男	26	89	1.23	0.267	<5	27	116	12.23	<0.001
女	24	57	1.23	0.267	肿瘤部位
糖尿病					左半结肠	19	58	0.05	0.829
有	14	29	1.44	0.230	右半结肠	31	88	0.05	0.829
无	36	117	1.44	0.230	病理类型
高血压					腺癌	31	104	3.44	0.179
有	16	29	3.10	0.078	黏液腺癌	13	35
无	34	117	3.10	0.078	其他	6	7
肠梗阻					肿瘤分化
有	8	20	0.16	0.688	低分化	10	21	0.88	0.348
无	42	126	0.16	0.688	中高分化	40	125	0.88	0.348
CA19-9（U/ml）					T分期
>40	16	21	7.55	0.006	T_3-4	23	26	15.79	<0.001
≤40	34	125	7.55	0.006	T_1-2	27	120	15.79	<0.001
CEA（ng/ml）					脉管癌栓
>5	12	20	2.89	0.089	有	19	21	12.79	<0.001
≤5	38	126	2.89	0.089	无	31	125	12.79	<0.001
组织类型					淋巴结转移
隆起型	26	54	5.37	0.068	有	26	32	16.18	<0.001
溃疡型	19	83			无	24	114	16.18	<0.001
浸润型	5	9

项目	肝转移（n=46）	无肝转移（n=150）	t/χ²值	P值	项目	肝转移（n=46）	无肝转移（n=150）	t/χ²值	P值
年龄（岁）	60.50±5.01	59.76±4.97	0.88	0.380	肿瘤部位
性别					左半结肠	19	58	0.10	0.749
男	28	87	0.12	0.730	右半结肠	27	92	0.10	0.749
女	18	63	0.12	0.730	病理类型
糖尿病					腺癌	30	105
有	10	33	0.01	0.970	黏液腺癌	10	38	4.03	0.134
无	36	117	0.01	0.970	其他	6	7
高血压					肿瘤分化
有	10	35	0.05	0.822	低分化	10	21	1.58	0.208
无	36	115	0.05	0.822	中高分化	36	129	1.58	0.208
肠梗阻					T分期
有	9	19	1.37	0.242	T_3-4	17	32	4.58	0.032
无	37	131	1.37	0.242	T_1-2	29	118	4.58	0.032
CA19-9（U/ml）					脉管癌栓
>40	15	22	7.40	0.007	有	18	22	12.97	<0.001
≤40	31	128	7.40	0.007	无	28	128	12.97	<0.001
CEA（ng/ml）					淋巴结转移
>5	8	24	0.05	0.823	有	19	39	3.96	0.047
≤5	38	126	0.05	0.823	无	27	111	3.96	0.047
组织类型					癌结节
隆起型	21	59			有	33	17	67.60	<0.001
溃疡型	20	82	2.36	0.307	无	13	133	67.60	<0.001
浸润型	5	9			癌结节直径（cm）	1.15±0.17	0.77±0.20	4.28	<0.001
手术方式					癌结节数量（枚）
腹腔镜	23	71	0.10	0.751	0	13	133	68.77	<0.001
开腹	23	79	0.10	0.751	1	22	9
肿瘤最大长径（cm）					2	5	4
≥5	20	33	8.23	0.004	3	6	4
<5	26	117	8.23	0.004

因素	β值	SE值	Wald χ²值	OR值	95%CI	P值
CA19-9	1.08	0.68	2.52	2.94	0.87~5.97	0.172
肿瘤最大长径	1.04	0.87	1.42	2.83	0.48~3.06	0.835
T_3-4期	1.53	0.70	4.78	4.62	1.51~7.35	0.003
脉管癌栓	1.69	0.94	3.23	5.42	1.75~12.85	<0.001
淋巴结转移	1.20	0.74	2.63	3.20	0.76~7.74	0.422
癌结节	2.92	1.66	3.09	18.54	7.45~39.73	<0.001
癌结节直径	2.58	1.57	2.70	13.20	4.74~29.64	<0.001
癌结节数量
1枚	2.21	1.64	1.82	9.11	2.24~27.34	<0.001
2枚	1.85	0.72	6.60	6.36	1.38~9.08	<0.001
3枚	1.61	0.88	3.35	5.00	1.98~8.84	<0.001