结直肠癌伴肝转移患者同期根治性切除术后复发与肿瘤生物学特征的相关性研究

Correlation between tumor biological characteristics and postoperative recurrence in patients with colorectal cancer and liver metastases undergoing synchronous radical resection

摘要:

目的 探讨结直肠癌伴肝转移患者同期根治性切除术后复发与肿瘤生物学特征的相关性。方法 选取2022年1月—2024年1月锦州医科大学附属第一医院收治的结直肠癌伴肝转移患者108例，所有患者行腹腔镜下结直肠癌根治性切除及大范围肝段或肝叶切除。记录患者术后1年的复发情况，分为复发组和非复发组。比较两组的术前肿瘤生物学特征及肿瘤标志物水平，分析结直肠癌伴肝转移患者术后复发的危险因素。结果 两组患者性别构成、年龄、体质量指数、结直肠癌家族史、肝功能分级比较，差异均无统计学意义（P >0.05）。两组患者原发肿瘤部位、病理类型、分化程度、T分期比较，差异均无统计学意义（P >0.05）。复发组N2分期占比高于非复发组（P <0.05）。复发组肝双叶转移占比、转移瘤数目> 1个和同时性肝转移占比及转移瘤最大径均高于非复发组（P <0.05）。两组患者癌胚抗原、糖类抗原19-9、甲胎蛋白水平和p53蛋白（+）占比比较，差异均无统计学意义（P >0.05）。复发组nm23蛋白（+）占比低于非复发组（P <0.05）。多因素逐步Logistic回归分析结果显示：N2分期［O^R=4.509（95% CI：2.024，10.044）］、肝双叶转移［O^R=4.354（95% CI：1.954，9.699）］、转移瘤数目多［O^R=4.076（95% CI：1.829，9.079）］、同时性肝转移［O^R=3.725（95% CI：1.672，8.298）］、转移瘤最大径大［O^R=4.884（95% CI：2.192，10.881）］均是结直肠癌伴肝转移患者术后复发的危险因素（P <0.05），nm23蛋白（+）［O^R=0.502（95% CI：0.225，1.118）］是结直肠癌伴肝转移患者术后复发的保护因素（P <0.05）。。结论 N分期、肝双叶转移、转移瘤数目、同时性肝转移、转移瘤最大径、nm23蛋白（+）表达与结直肠癌伴肝转移患者的术后复发有关。

Abstract:

Objective To explore the correlation between tumor biological characteristics and postoperative recurrence in patients with colorectal cancer and liver metastases undergoing synchronous radical resection.Methods A total of 108 patients with colorectal cancer and liver metastases who were treated at our hospital from January 2022 to January 2024 were selected. All patients underwent laparoscopic radical resection of colorectal cancer and extensive hepatic segmentectomy or hepatectomy. The recurrence status of patients was recorded one year after surgery, and they were divided into a recurrence group and a non-recurrence group. The preoperative tumor biological characteristics and tumor marker levels of the two groups were compared, and the risk factors for postoperative recurrence in patients with colorectal cancer and liver metastases were analyzed.Results Comparisons of baseline characteristics, including sex distribution, age, body mass index, family history of colorectal cancer, and liver function grading, showed no significant differences between the two groups (P > 0.05). Similarly, no significant differences were observed in primary tumor location, pathological type, degree of differentiation, or T stage (P > 0.05). However, the recurrence group had a higher proportion of N2 stage disease compared with the non-recurrence group (P < 0.05). Patients in the recurrence group also exhibited higher rates of bilateral liver metastases, number of metastatic lesions >1, synchronous liver metastases, and larger maximum diameter of metastases than those in the non-recurrence group (P < 0.05). No significant differences were found between the two groups in serum levels of CEA, CA19-9, and AFP, or the proportion of p53-positive cases (P > 0.05). Conversely, the proportion of nm23-positive cases was lower in the recurrence group than in the non-recurrence group (P < 0.05). Multivariable logistic regression analysis identified N2 stage [O^R = 4.509 (95% CI: 2.024, 10.044) ], bilateral liver metastases [O^R = 4.354 (95% CI: 1.954, 9.699) ], greater number of metastatic lesions [O^R = 4.076 (95% CI: 1.829, 9.079) ], synchronous liver metastases [O^R = 3.725 (95% CI: 1.672, 8.298) ], larger maximum diameter of metastases [O^R = 4.884 (95% CI: 2.192, 10.881) ], and nm23 positivity [O^R = 5.018 (95% CI: 2.252, 11.178) ] as independent risk factors for postoperative recurrence in patients with colorectal cancer and liver metastases (all P < 0.05).Conclusion N stage, bilateral liver metastases, number of metastatic lesions, synchronous liver metastases, maximum diameter of metastases, and nm23 positivity are associated with postoperative recurrence in patients with colorectal cancer and liver metastases.