结直肠癌根治术后骨转移的危险因素及潜在预测指标初探
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摘要
目的探索结直肠癌根治术后发生骨转移的主要影响因素及潜在预测指标。方法选取我院收治的结直肠癌患者513例,记录其一般资料。随访5年,出现骨转移的患者定义为骨转移组。COX回归分析对骨转移产生显著影响的独立影响因素。ROC曲线分评价潜在指标对术后骨转移的预测能力。结果 Cox回归显示细胞分化程度(P=0.018)、浸润深度(P=0.038)、EGFR阳性表达(+++)(P=0.013)、HER2阳性表达(+++)(P=0.026)、术后CEA水平(P=0.002)、术前CA199水平(P=0.001)及术前CA242水平(P=0.031)对结直肠癌患者术后骨转移不良预后有影响;术后CEA水平和术前CA242水平二者联合的AUC为0.885,其特异度为88.5%,敏感度为84.8%。结论本研究表明浸润深度、细胞分化程度、EGFR阳性高表达、HER2阳性高表达、术前CEA水平及术前CA199水平是结直肠癌根治术后骨转移的独立危险因素,术后CEA水平和术前CA242水平二者联合检测可对骨转移预后进行预测。
Objective To explore the main influential factors and potential predictors of bone metastasis after radical operation of colorectal cancer. Methods A total of 513 colorectal cancer patients admitted to our hospital were selected and their baseline data were recorded. All patients were followed up for 5 years. Patients with bone metastases were defined as the bone metastasis group. Cox regression analysis was used to evaluate the independent prognostic factors. The factors in predicting prognosis were calculated by ROC curves. Results The Cox regression showed that the depth of invasion(P = 0.038),cell differentiation(P = 0.018),EGFR positive expression(+++)(P = 0.013),HER2 positive expression(++)(P = 0.026),postoperative CEA level(P = 0.002),preoperative CA199 level(P = 0.001)and preoperative CA242 level(P = 0.003)had a significant effect on the prognosis of patients with colorectal cancer which was poor prognosis of bone metastasis. The AUC of the combination of CEA and CA242 level was 0.885,the specificity was 88.5%,the sensitivity was 84.8%. Conclusions The depth of invasion,cell differentiation,EGFR positive expression(+++),HER2 positive expression(++),postoperative CEA levels,preoperative CA199 levels and preoperative CA242 level are independent factors for bone metastasis after radical resection of colorectal cancer,combined diagnosis of postoperative CEA levels and preoperative CA242 levels can predict the prognosis of bone metastases.
Objective To explore the main influential factors and potential predictors of bone metastasis after radical operation of colorectal cancer. Methods A total of 513 colorectal cancer patients admitted to our hospital were selected and their baseline data were recorded. All patients were followed up for 5 years. Patients with bone metastases were defined as the bone metastasis group. Cox regression analysis was used to evaluate the independent prognostic factors. The factors in predicting prognosis were calculated by ROC curves. Results The Cox regression showed that the depth of invasion(P = 0.038),cell differentiation(P = 0.018),EGFR positive expression(+++)(P = 0.013),HER2 positive expression(++)(P = 0.026),postoperative CEA level(P = 0.002),preoperative CA199 level(P = 0.001)and preoperative CA242 level(P = 0.003)had a significant effect on the prognosis of patients with colorectal cancer which was poor prognosis of bone metastasis. The AUC of the combination of CEA and CA242 level was 0.885,the specificity was 88.5%,the sensitivity was 84.8%. Conclusions The depth of invasion,cell differentiation,EGFR positive expression(+++),HER2 positive expression(++),postoperative CEA levels,preoperative CA199 levels and preoperative CA242 level are independent factors for bone metastasis after radical resection of colorectal cancer,combined diagnosis of postoperative CEA levels and preoperative CA242 levels can predict the prognosis of bone metastases.
引文
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[10]LI L,NI B B,ZHONG Q H,et al.Investigation of correlationbetween mutational status in key EGFR signaling genes andprognosis of stage II colorectal cancer[J].Future Oncol,2017,13(17):1473.
[11]OKAMURA R,HIDA K,HASEGAWA S,et al.Impact of in-traoperative blood loss on morbidity and survival after radicalsurgery for colorectal cancer patients aged 80 years or older[J].Int J Colorectal Dis,2016,31(2):1-8.
[12]TAKEGAWA N,YONESAKA K.HER2 as an emerging oncotar-get for colorectal cancer treatment after failure of anti-epidermalgrowth factor receptor therapy[J].Clin Colorectal Cancer,2017,16(4):247-251.
[13]MAURER C A,DIETRICH D,SCHILLING M K,et al.Pro-spective multicenter registration study of colorectal cancer:sig-nificant variations in radicality and oncosurgical quality-SwissGroup for Clinical Cancer Research Protocol SAKK 40/00[J].Int J Colorectal Dis,2016,32(1):1-18.
[14]PINDAK D,PAVLENDOVA J,TOMAS M,et al.Selective ver-sus routine lymphadenectomy in the treatment of liver metastasisfrom colorectal cancer:a retrospective cohort study[J].BMCSurg,2017,17(1):34.
[15]唐金凤,肖久长,陈先春,等.结直肠癌血清CEA与CA199及CA724联合检测价值分析[J].中华肿瘤防治杂志,2016(s2):46-47.
[2]HAN D,GAO X,WANG M,et al.Long noncoding RNA H19indicates a poor prognosis of colorectal cancer and promotes tu-mor growth by recruiting and binding to e IF4A3[J].Oncotar-get,2016,7(16):22159-22173.
[3]MOKUTANI Y,UEMURA M,MUNAKATA K,et al.Down-regulation of microrna-132 is associated with poor prognosis ofcolorectal cancer[J].Ann Surg Oncol,2016,23(5):599-608.
[4]TSAI H L,HUANG C W,CHEN C W,et al.Survival in re-sected stage ii colorectal cancer is dependent on tumor depth,vascular invasion,postoperative cea level,and the number ofexamined lymph nodes[J].World J Surg,2016,40(4):1002-1009.
[5]TANAKA M,KANEMITSU Y,SHIDA D,et al.Prognostic im-pact of intra-abdominal/pelvic inflammation after radical surgeryfor locally recurrent rectal cancer[J].Dis Colon Rectum,2017,60(8):827-836.
[6]BOSTEL T,FORSTER R,SCHLAMPP I,et al.Spinal bonemetastases in colorectal cancer:a retrospective analysis of sta-bility,prognostic factors and survival after palliative radiothera-py[J].Radiat Oncol,2017,12(1):115.
[7]SU J,ZHANG E,LIANG H,et al.Long noncoding RNA BLA-CAT1 indicates a poor prognosis of colorectal cancer and affectscell proliferation by epigenetically silencing of p15[J].CellDeath Dis,2017,8(3):e2665.
[8]宋均飞,刘弋.EGFR、HER2在结直肠癌患者血清与组织中的表达及其临床意义分析[J].中华疾病控制杂志,2016,20(4):403-407.
[9]庞歆桥,赵鹏飞,杨凡,等.黄芪甲苷联合西妥昔单抗对人结肠癌细胞系RKO自噬调节与增殖的抑制作用[J].实用医学杂志,2016,32(18):2992-2995.
[10]LI L,NI B B,ZHONG Q H,et al.Investigation of correlationbetween mutational status in key EGFR signaling genes andprognosis of stage II colorectal cancer[J].Future Oncol,2017,13(17):1473.
[11]OKAMURA R,HIDA K,HASEGAWA S,et al.Impact of in-traoperative blood loss on morbidity and survival after radicalsurgery for colorectal cancer patients aged 80 years or older[J].Int J Colorectal Dis,2016,31(2):1-8.
[12]TAKEGAWA N,YONESAKA K.HER2 as an emerging oncotar-get for colorectal cancer treatment after failure of anti-epidermalgrowth factor receptor therapy[J].Clin Colorectal Cancer,2017,16(4):247-251.
[13]MAURER C A,DIETRICH D,SCHILLING M K,et al.Pro-spective multicenter registration study of colorectal cancer:sig-nificant variations in radicality and oncosurgical quality-SwissGroup for Clinical Cancer Research Protocol SAKK 40/00[J].Int J Colorectal Dis,2016,32(1):1-18.
[14]PINDAK D,PAVLENDOVA J,TOMAS M,et al.Selective ver-sus routine lymphadenectomy in the treatment of liver metastasisfrom colorectal cancer:a retrospective cohort study[J].BMCSurg,2017,17(1):34.
[15]唐金凤,肖久长,陈先春,等.结直肠癌血清CEA与CA199及CA724联合检测价值分析[J].中华肿瘤防治杂志,2016(s2):46-47.