【摘要】 目的评价淋巴结被膜外侵犯在结直肠癌肝转移行肝部分切除术后的预后价值。方法回顾性分析新疆医科大学第一附属医院2002年1月-2012年12月收治的78例行肝切除术的结直肠癌肝转移患者的临床资料,对所有术后淋巴结病理标本进行重新评估,对临床病理资料、生存期进行关联分析,并通过long-rank检验和Cox模型对影响预后的相关因素进行分析。结果 (1)78例结直肠癌肝转移肝切除术后患者中39例有淋巴结被膜外侵犯,21例有多发肝转移灶,30例肝转移灶直径≥2cm,34例肝切除术切缘范围≥1cm,淋巴结转移阳性和阴性差异无统计学意义。(2)39例淋巴结被膜外侵犯病例,男女比例为1.05∶1,26例发生在结肠,21例为同时性肝转移,淋巴结被膜外侵犯与性别、年龄、原发灶的部位、大小、浸润深度、肝转移程度、肝转移灶直径等无关,但与肝转移时间(P=0.037)、淋巴结转移数目(P=0.001)、肝转移灶数目(P=0.000)显著相关。(3)结直肠癌肝转移后行肝切除术的患者中位生存期为16(4~84)个月,淋巴结转移阴性患者为54(22~84)个月,淋巴结被膜外转移阴性患者为19(16~22)个月,淋巴结被膜外转移阳性患者为11(4~22)个月,3组比较差异具有统计学意义(χ2=98.699,P<0.01)。(4)淋巴结数目(P=0.021)、淋巴结被膜外侵犯(P=0.002)、术前术后辅助化疗(P=0.000)差异均具有统计学意义(P<0.05)。淋巴结数目、淋巴结被膜外侵犯为影响肝转移灶切除预后的独立因素。结论区域淋巴结的被膜外侵犯是肝切除术后的不良预后因素。更多还原

【Abstract】 Objective To evaluate prognosis of extracapsular spread(ECS)of lymph node for metastatic colorectal cancer(CRC)following liver resection.Methods We did a retrospective analysis of 75 patients with CRC following liver resection from the first affiliated hospital of Xinjiang medical university and the second affiliated hospital of Jilin university from January 2002 and December 2012.All of those preoperative,intraoperative and postoperative data were retrospectively reviewed.All resected lymph nodes from primary CRC were re-examined to assess ECS.Associations between clinicopathologic factors and survival were made,affecting the prognosis for single factor and multiple factors analysis through the long-rank test and Cox model related factors.Results ECS was identified in 39 patients,timing of liver metastasis(P =0.037),the number of lymph node metastasis(P =0.001),number of liver metastases(P =0.000).Univariate analysis showed that the number of lymph nodes(P=0.021),lymph node capsule invasion(P =0.002),preoperative adjuvant chemotherapy after surgery(P =0.000),were the important prognostic factors.Multifactor analysis showed that lymph node capsule invasion(P=0.032),number of lymph nodes(P =0.012)were the independent prognosis factors.Conclusion ECS in regional lymph node is a poor prognostic factors after liver resection for CRC.更多还原