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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。
Objective To evaluate the prognostic value of extranodal invasion of lymph nodes in patients with liver metastases from colorectal cancer after partial hepatectomy. Methods The clinical data of 78 patients with liver metastases from colorectal cancer who underwent hepatectomy from January 2002 to December 2012 in the First Affiliated Hospital of Xinjiang Medical University were retrospectively analyzed. All postoperative pathological specimens of lymph nodes were reevaluated, The clinicopathological data and survival time were analyzed, and related factors influencing prognosis were analyzed by long-rank test and Cox model. Results (1) Thirty-nine cases of colorectal cancer after liver resection and liver resection had 39 cases of extranodal invasion of lymph nodes, 21 cases of multiple liver metastases, 30 cases of liver metastases> 2 cm in diameter, and 34 cases of hepatectomy ≥ 1cm, lymph node metastasis positive and negative differences were not statistically significant. (2) Thirty-nine cases of extranodal invasion of lymph nodes, the ratio of male to female was 1.05:1, 26 cases occurred in the colon, 21 cases of simultaneous liver metastases, extranodal invasion of lymph nodes and gender, age, location of primary tumor, size, (P = 0.037), the number of lymph node metastasis (P = 0.001) and the number of liver metastases (P = 0.000). (3) The median survival time of patients who underwent hepatectomy for colorectal cancer after hepatectomy was 16 (4-84) months, 54 (22-84) months were negative patients with lymph node metastasis, 19 (16-22) months, lymph node metastasis positive patients were 11 (4 ~ 22) months, the difference between the three groups was statistically significant (χ2 = 98.699, P <0.01). (4) The number of lymph nodes (P = 0.021), the extranodal invasion of lymph nodes (P = 0.002) and the postoperative adjuvant chemotherapy (P = 0.000) were statistically significant (P <0.05). The number of lymph nodes, extranodal invasion of lymph nodes is an independent factor affecting the prognosis of resection of liver metastases. Conclusion The extracapsular invasion of regional lymph nodes is a poor prognostic factor after hepatectomy.