| BackgroundColorectal cancer(CRC)is a malignant tumor that occurs in the intestines and is increasingly becoming one of the most common tumors in the world.Its high morbidity and mortality are a serious threat to human health.The prevalence of colorectal cancer is getting higher and higher.In addition to its own genetic factors,a large part of it is the cause of diet and aging.The latest statistics show that the prevalence of colorectal cancer ranks third in the world and ranks third among all deadly malignancies.In China,the incidence of colorectal cancer ranks fourth among all malignant tumor diseases and ranks fifth among all malignant tumors that cause death.Colorectal cancer is a malignant tumor that can cause distant metastasis.Lymph node metastasis plays an important role in all possible metastases and is directly related to the postoperative recurrence rate and mortality of patients with colorectal cancer.The T1 phase refers to a tumor invading the mucosal layer or the submucosa.In general,stage T1 colorectal cancer is relatively rare.According to relevant literature reports,the incidence of colorectal cancer in stage T1 was 3.51%.In the case of ensuring complete removal of tumors,patients with T1 colorectal cancer tend to have a relatively good prognosis.However,colorectal cancer in stage T1 is not often associated with lymph node metastasis.Therefore,it is often overlooked during the diagnosis and treatment of diseases.Despite this,lymph node metastasis remains one of the most important prognostic risk factors for colorectal cancer in stage T1 and has been reported to have a certain incidence.Therefore,there is a certain need for the study of lymph node metastasis of colorectal cancer in stage T1,and it may become a key factor in the cure rate of patients.At present,research on lymph node metastasis has become more and more perfect,and research on T1 lymph node metastasis has received more and more attention.ObjectiveTo investigate the rule of lymph node metastasis of colorectal cancer in stage T1and its effect on the prognosis of colorectal cancer.MethodsThis study collected 321 cases of T1 colorectal cancer hospitalized from the First Affiliated Hospital of Zhengzhou University from January 2002 to January 2012.The collected cases were diagnosed by pathology and surgically treated.Including 27cases(8.41%)with lymph node metastasis and 294 cases(91.59%)without lymph node metastasis.There were 172 males and 149 females.174 cases were aged?60years old,and 147 cases were<60 years old.The average age of the patients was61.37±13.41 years old.There were 42 smoking cases and 279 non-smoking cases.Preoperative serum CEA level<5?g/L in 284 cases,?5?g/L in 37 cases.Preoperative serum CA199 level<9U/ml in 173 cases,?9U/ml in 148 cases.Preoperative serum CA724<2U/ml 163 cases,?2U/ml in 158 cases The absolute value of granulocytes was less than 2.2×10~9 in 32 cases,and greater than or equal to 2.2×10~9 in 289 cases.There were 158 cases of d-dimer<0.21g/L and 163 cases of d-dimer?0.21g/L.154cases had hemoglobin<132g/L and 167 cases had hemoglobin?132g/L.There were 8cases with angioma thrombus and 313 cases without it.The tumors were located in rectum in 170 cases and colon in 151 cases.There were 190 cases with tumor size<3.0cm and 131 cases with tumor size?3.0cm.Differentiation degree:there were307 cases of high-medium differentiation and 14 cases of low differentiation.The general types of tumors were non-ulcerative in 238 cases and ulcerative in 83 cases.Tissue type:adenocarcinoma in 312 cases,non-adenocarcinoma in 9 cases.The correlation between lymph node metastasis in stage T1 colorectal cancer and clinicopathological parameters was studied using X2 test and Logistic multivariate regression analysis.Kaplan-meier method and Cox regression analysis were used to study the effect of lymph node metastasis on the prognosis of T1 stage colorectal cancer.Results1.A total of 321 cases of colorectal cancer in T1 were collected in this study and the proportion of lymph node metastasis was 8.41%(27/321),the proportion without lymph node metastasis was 91.59%(294/321).2.Univariate analysis showed that serum CEA,serum CA199,serum CA724,vascular tumor thrombus and differentiation were associated with lymph node metastasis of colorectal cancer in T1(P<0.05).3.Logistic regression analysis showed that serum CA724,vascular tumor thrombus and differentiation were closely related to lymph node metastasis of colorectal cancer in T1(P<0.05).4.Kaplan-meier method and log-rank method showed that age,serum CEA,serum CA199,vascular tumor thrombus,degree of differentiation and lymph node metastasis(X2=24.180,P<0.001)were predictors of 5-year survival(OS)in T1colorectal cancer patients(P<0.05).5.Cox regression analysis showed that serum CA199 and lymph node metastasis(HR=5.117;P<0.05;95%CI:0.058-0.815)were independent prognostic indicators of5-year survival rate(OS)in patients with colorectal cancer in stage T1(P<0.05).ConciusionIn this study,Serum CA724,vascular tumor thrombus and degree of differentiation were independent risk factors for lymph node metastasis,among which lymph node metastasis was an independent prognostic factor affecting the 5-year survival rate(OS)of T1 stage colorectal cancer. |
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