左、右半结肠癌骨转移病理特征及预后分析
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摘要
目的:比较左半结肠癌(LSCC)和右半结肠癌(RSCC)骨转移的病理特征和临床预后差异。方法:对漯河市中心医院2007年1月至2015年12月收治的103例结肠癌骨转移病例资料进行回顾性分析,据解剖位置将64例纳入LSCC组,39例纳入RSCC组,对比分析其病理学特征,绘制并分析生存曲线,筛选预后因素。结果:RSCC骨转移相对LSCC表现为:CA199阳性率高、年龄大、分化程度更差、分期更晚、预后更差。单因素分析结果示原发肿瘤位置、TNM分期、LDH水平、ALP水平是影响结肠癌骨转移3年生存的相关因素。Logistic多因素回归分析显示原发肿瘤位置、TNM分期、ALP水平是结肠癌骨转移的独立危险因素。结论:左、右半结肠癌在病理特点、临床表现、生物学行为、生存预后等方面存在差异,本文为区分左、右半结肠癌骨转移的不同病理特征及预后评价提供了依据。
Objective: To compare the pathologic features,prognostic factors and prognostic factors of patients with left and right colon cancer bone metastases. Methods: We retrospectively analyzed the clinical data of 103 patients with colon cancer bone metastases from January 2007 to December 2015 in Luohe Central Hospital. Patients were divided into left-side colon cancer( LSCC) and right-side colon cancer( RSCC) according to the different locations,and to analyze the pathologic features and prognosis of left and right colonic bone metastases. Results: Chi-square test showed RSCC bone metastasis compared with LSCC bone metastasis showed CA199 level abnormalities,older age,low differentiation,late stage,poor survival. Univariate analysis showed that the factors affecting the survival of the three years included tumor location,TNM stage,lactate dehydrogenase( LDH) and alkaline phosphatase( ALP). Multivariate analysis showed that the location of tumor,TNM stage and ALP level were the independent prognostic risk factors of colon cancer bone metastasis for 3 years. Conclusion: LSCC bone metastasis and RSCC bone metastasis was significantly different in pathological features,clinical manifestations,biological behaviors,survival and prognosis.
Objective: To compare the pathologic features,prognostic factors and prognostic factors of patients with left and right colon cancer bone metastases. Methods: We retrospectively analyzed the clinical data of 103 patients with colon cancer bone metastases from January 2007 to December 2015 in Luohe Central Hospital. Patients were divided into left-side colon cancer( LSCC) and right-side colon cancer( RSCC) according to the different locations,and to analyze the pathologic features and prognosis of left and right colonic bone metastases. Results: Chi-square test showed RSCC bone metastasis compared with LSCC bone metastasis showed CA199 level abnormalities,older age,low differentiation,late stage,poor survival. Univariate analysis showed that the factors affecting the survival of the three years included tumor location,TNM stage,lactate dehydrogenase( LDH) and alkaline phosphatase( ALP). Multivariate analysis showed that the location of tumor,TNM stage and ALP level were the independent prognostic risk factors of colon cancer bone metastasis for 3 years. Conclusion: LSCC bone metastasis and RSCC bone metastasis was significantly different in pathological features,clinical manifestations,biological behaviors,survival and prognosis.
引文
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[2]Underhill ML,Germansky KA,Yurgelun MB,et al.Advances in hereditary colorectal and pancreatic cancers[J].Clin Ther,2016,38(7):1600-1621.
[3]M Katoh,M Unakami,M Hara,et al.Bone metastasis from colorectal cancer in autopsy cases[J].J Gastroenterol 1995,30(5):615-618.
[4]JA Bufill.Colorectal cancer:Evidence for distinct genetic categories based on proximal or distal tumor location[J].Ann Intern Med,1990,113(10):779-788.
[5]Wu JX,Li XH,Qi FZ.Diagnosis and treatment of bone metastases from colorectal carcinoma with a repot of 28 cases[J].Chin J Bone Tumor and Bone Disease,2003,2(4):215-216.[吴健雄,李兴华,祁付珍.结直肠骨转移28例诊治分析[J].中国骨肿瘤骨病,2003,2(4):215-216.]
[6]SC Nahas,CS Nahas,LA Bustamante-Lopez,et al.Prognostic factors of surgically-treated patients with cancer of the right colon:Aten years'experience of a single universitary institution[J].Arq Bras Cir Dig,2015,28(1):3-7.
[7]RA Meguid,MB Slidell,CL Wolfgang,et al.Is there a difference in survival between right-versus left-sided colon cancers[J]?Ann Surg Oncol,2008,15(9):2388-2394.
[8]F Benedix,R Kube,F Meyer,et al.Comparison of 17,641 patients with right-and left-sided colon cancer:Differences in epidemiology,perioperative course,histology,and survival[J].Dis Colon Rectum,2010,53(1):57-64.
[9]I Laake,I Thune,R Selmer,et al.A prospective study of body mass index,weight change,and risk of cancer in the proximal and distal colon[J].Cancer Epidemiol Biomarkers Prev,2010,19(6):1511-1522.
[10]V Jurisic,S Radenkovic,G Konjevic,et al.The actual role of LDHas tumor marker,biochemical and clinical aspects[J].Adv Exp Med Biol,2015,867:115-124.
[11]Xin Y,Han BH,Lou JT.Diagnostic significance of bone metabolites markers ICTP and BAP in bone metastasis of lung cancer[J].Chinese Journal of Lung Cancer,2010,13(10):947-953.[忻宇,韩宝惠,娄家陶.骨代谢标志物ICTP、BAP对肺癌骨转移的诊断意义[J].中国肺癌杂志,2010,13(10):947-953.]
[12]Ge YL,Zhang Z.The value of bone alkaline phosphatase in the diagnosis of bone tumors[J].Chinese Journal of Medical Laboratory Science,2006,29(2):136-139.[葛艳玲,张正.骨型碱性憐酸酶在骨肿瘤诊断中的价值[J].中华检验医学杂志,2006,29(2):136-139.]
[13]Hong RX,Lin QJ,Luo J,et al.Clinical featuers and prognosis in104 colorectal cancer patients with bone metadtases[J].Chin JOncol,2013,35(10):787-791.[洪若熙,林秋菊,罗健,等.104例结直肠癌骨转移患者的临床特征及预后[J].中华肿瘤杂志,2013,35(10):787-791.]
[14]JM Bae,JH Kim,NY Cho,et al.Prognostic implication of the CpGisland methylator phenotype in colorectal cancers depends on tumour location[J].Br J Cancer,2013,109(4):1004-1012.
[15]M Gnant,M Balic,E Petru,et al.Treatment of bone metastases in patients with advanced breast cancer[J].Breast Care(Basel),2012,7(2):92-98.
[16]T Yokota,T Ura,N Shibata,et al.BRAF mutation is a powerful prognostic factor in advanced and recurrent colorectal cancer[J].Br J Cancer,2011,104(5):856-862.
[17]J Humphris,DK Chang,AV Biankin,et al.Inherited susceptibility to pancreatic cancer in the era of next-generation sequencing[J].Gastroenterology,2015,148(3):496-498.