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目的探讨影响结直肠癌根治术后5年内脑转移的危险因素。方法回顾性分析2003年1月至2011年12月间第二军医大学长海医院肛肠外科收治的1 104例结直肠癌患者的临床资料,其中30例(2.7%)术后出现脑转移。所有患者均行结直肠癌根治性切除术,其中直肠癌患者遵循全直肠系膜切除(total mesorectal excision,TME)原则。术后TME分期提示为Ⅱ期或更晚分期的患者,根据情况接受卡培他滨联合奥沙利铂方案(XELOX)或氟尿嘧啶联合奥沙利铂方案(FOLFOX)的化疗。分别采用χ2检验和logistic多因素分析模型,对性别、年龄、肿瘤位置、术前血清癌胚抗原(CEA)水平、肿瘤组织学类型、肿瘤浸润深度、是否有淋巴结转移、是否伴肺转移、是否伴肝转移等可能影响术后脑转移的临床病理特征进行单因素和多因素分析。结果单因素分析显示,肿瘤位置(χ2=5.844,P=0.016)、术前血清CEA水平(χ2=5.395,P=0.020)、肿瘤组织学类型(χ2=4.950,P=0.026)和是否伴肺转移(χ2=52.569,P=0.000)是影响结直肠癌根治术后5年内脑转移的相关因素。Logistic多因素分析显示,肿瘤位置(OR=0.278,95%CI:0.095~0.817,P=0.020)、术前血清CEA水平(OR=0.423,95%CI:0.192~0.933,P=0.033)和是否伴肺转移(OR=10.814,95%CI:4.705~24.856,P=0.000)是影响结直肠癌根治术后5年内发生脑转移的独立危险因素。结论肿瘤位置为直肠、高术前CEA水平及伴有肺转移的结直肠癌患者术后5年内更容易发生脑转移。
Objective To explore the risk factors of brain metastasis within 5 years after radical operation of colorectal cancer. Methods The clinical data of 1 104 patients with colorectal cancer admitted to Changhai Hospital, Changhai Hospital, Second Military Medical University from January 2003 to December 2011 were retrospectively analyzed. Among them, 30 patients (2.7%) had brain metastases after operation. All patients underwent radical resection of colorectal cancer, in which patients with rectal cancer followed the principle of total mesorectal excision (TME). Patients with postoperative TME staging of stage II or later were eligible for chemotherapy with capecitabine plus oxaliplatin (XELOX) or fluorouracil plus oxaliplatin (FOLFOX) as appropriate. Chi-square test and logistic multivariate analysis were used to analyze the gender, age, tumor location, preoperative serum CEA level, tumor histological type, tumor invasion depth, lymph node metastasis and lung metastasis With liver metastasis may affect the clinical pathological features of brain metastases after univariate and multivariate analysis. Results Univariate analysis showed that tumor location (χ2 = 5.844, P = 0.016), preoperative serum CEA level (χ2 = 5.395, P = 0.020), tumor histological type Metastasis (χ2 = 52.569, P = 0.000) was associated with brain metastases within 5 years after radical resection of colorectal cancer. Logistic multivariate analysis showed that tumor location (OR = 0.278, 95% CI: 0.095-0.817, P = 0.020), preoperative serum CEA level (OR = 0.423, 95% CI: 0.192-0.933, P = 0.033) Pulmonary metastasis (OR = 10.814, 95% CI: 4.705-24.856, P = 0.000) was an independent risk factor for brain metastasis within 5 years after radical resection of colorectal cancer. Conclusion The location of tumor in rectum, high preoperative CEA level and lung metastasis in patients with colorectal cancer more likely to occur within 5 years after the brain metastases.