作者：刘庆睿，姜宪

单位：哈尔滨医科大学附属第一医院 胃肠外科，黑龙江 哈尔滨 150001

Authors: Liu Qingrui, Jiang Xian

Unit: Gastrointestinal Surgery, the First Affiliated Hospital Of Harbin Medical University, Harbin 150001, Heilongjiang, China

摘要：

目的 探讨不同临床特征中结肠癌肝转移(CCLM)患者临床特征及预后危险因素。方法 收集监测、流行病学、最终结果 (SEER)数据库中2010—2015年的13 346例结肠癌患者的病历资料,根据是否发生肝转移分为肝转移组(1614例)和非肝转移组(11 732例),评估各临床特征对结肠癌(CC)发生肝转移及CCLM患者预后的影响。结果 年龄<65岁、男性、黑种人、肿瘤直径处于39～78 mm之间、肿瘤未分化、肿瘤位于乙状结肠、肿瘤病理为腺癌、癌胚抗原(CEA)高于正常值、肿瘤侵及浆膜层及以上(T4)、淋巴结广泛转移(N2)是影响CC发生肝转移的独立危险因素。年龄>75岁、肿瘤直径>78 mm、肿瘤未分化、右半结肠癌、印戒细胞癌、CEA高于正常值、肿瘤侵及浆膜(T4)、周围淋巴结广泛转移(N2)、未手术(包括原发灶及转移灶)及未化疗是CCLM患者预后不良的独立危险因素。结论 除肿瘤大小、位置、病理类型、浸润深度、分化程度、淋巴结转移程度外,年龄、性别、种族和CEA水平等也是影响CC发生肝转移的独立因素。患者的年龄、肿瘤的部分临床特征及CEA水平影响CCLM患者生存率。原发灶和转移灶是否手术、是否联合化学治疗是影响患者预后的独立危险因素。

关键词：结肠癌肝转移；预后危险因素；SEER数据库

Abstract：

Objective To explore the clinical characteristics and prognostic risk factors of patients with colon cancer liver metastases （CCLM）. Method The medical records of 13 346 patients with colon cancer in Surveillance, Epidemiology and final outcome （SEER） database from 2010 to 2015 were collected. According to the occurrence of liver metastasis, they were divided into liver metastasis group （n=1614） and non-liver metastasis group （n=11 732）. The effects of clinical features on liver metastasis in CC and prognosis of CCLM patients were evaluated. Result The results of statistical analysis showed that age less than 65 years old, male, black people, tumor diameter between 39 mm- 78 mm, tumor undifferentiated, tumor located in sigmoid colon, adenocarcinoma pathologically, carcinoembryonic antigen （CEA） higher than normal, tumor invading serosa and above （T4 ）, extensive lymph node metastasis （N2） were independent risk factors for liver metastasis of CC. Age over 75 years old, tumor diameter larger than 78 mm, undifferentiated tumor, right colon cancer, signet ring cell carcinoma, CEA higher than normal, tumor invading serosa （T4）, extensive metastasis of peripheral lymph nodes （N2）, unoperated （including primary and metastatic lesions） and non-chemotherapy were independent risk factors for poor prognosis in patients with CCLM. Conclusion Besides tumor size, location, pathological type, depth of invasion, degree of differentiation and degree of lymph node metastasis, age, sex, race and CEA level are also independent factors affecting liver metastasis in CC. The age of the patients, some clinical features of the tumor and the level of CEA affect the survival rate of patients with CCLM. Whether the primary focus and metastasis are operated and whether combined with chemotherapy are independent risk factors affecting the prognosis of patients.

Key Words: Colon cancer with liver metastasis; Prognosis risk factors; SEER database