Comprehensive Analysis Of Preoperative Risk Factors To Predict Liver Metastasis Of Colorectal Cancer

Objective:To study the predictive value of clinical pathological factors and preoperative serum CEA,CA19-9 and alkaline phosphatase levels in liver metastasis of colorectal cancer.Methods:A total of 365 patients who underwent surgical treatment of colorectal cancer at Qingdao Municipal Hospital from January 2016 to January 2019 were selected as the research subjects.They were divided into liver metastasis group and non-liver metastasis group according to whether the patients had liver metastases.Collect clinical data of patients,including age,gender,surgical stoma,tumor location,tumor size,level of differentiation,degree of invasion,number of regional lymph node metastases,and serum CEA,CA19-9 and alkaline phosphatase test results before surgery and build the database.SPSS 23.0 statistical software was used for analysis,and the normality of the measurement data distribution was studied by Kolmogorov-Smirnov test;the count data was used the chi-square test;the measurement data was used the Mann-Whitney test;Box plot was used to visually show the distribution differences of preoperative serum CEA,CA19-9 and alkaline phosphatase concentrations in colorectal cancer patients with or without liver metastasis and in each disease stage;univariate and multivariate analysis were used to establish a prediction model;The receiver operating characteristic curve was used to analyze the diagnostic validity of preoperative serum CEA,CA19-9 and alkaline phosphatase separately and the diagnostic validity of the prediction model,determined the cutoff value and the corresponding sensitivity and specificity,and screened the best indicators to predict the occurrence of liver metastasis in colorectal cancer.Results:Among the 365 patients enrolled,there were 79 cases in the liver metastasis group and 286 cases in the non-liver metastasis group.There was no significant difference between the two groups in terms of whether the operation was stoma,primary tumor site,tumor size,and tumor invasion depth?P>0.05?;Age is inversely related to the incidence of colorectal cancer liver metastasis.Patients younger than 60 years of age have a significantly higher risk of colorectal cancer liver metastasis than patients aged 60 years or older?P<0.01?;Compared with male patients,female patients had a lower risk of colorectal cancer liver metastasis,and the difference was statistically significant?P<0.05?;The lower the degree of differentiation,the higher the risk of liver metastasis from colorectal cancer,and the difference was statistically significant?P<0.05?;Patients with positive regional lymph node metastasis were more prone to liver metastasis than those with negative lymph node?P<0.01?;The levels of serum CEA,CA19-9,and alkaline phosphatase in patients with liver metastases were higher than those without liver metastases,and the difference was statistically significant?P<0.01?;Box plots visually indicate that the preoperative serum CEA,CA19-9,and alkaline phosphatase concentrations were distributed differently among disease stages in colorectal cancer patients,and the differences were statistically significant?P<0.05?;Multivariate logistic regression showed that age,CEA,CA19-9,and alkaline phosphatase were independent risk factors for colorectal cancer liver metastasis?P<0.05?,and a predictive model was established:P=1/(1+e_<sup>?-2.064-1.260X₁+0.008X₂+0.002X₃+0.014X₄?).The ROC curve analysis of the preoperative serum CEA cutoff value was 10.540ng/mL,the sensitivity was 55.7%,the specificity was 76.9%,the Youden index was 0.326,and the area under the curve was 0.710;The cutoff value of the preoperative serum CA19-9 is 18.160U/m L,the sensitivity is 57.0%,the specificity is 69.2%,the Youden index is 0.262,and the area under the curve is 0.629;the cutoff value of the preoperative serum alkaline phosphatase is 95.730U/L,sensitivity It is 57.0%,the specificity is 72.0%,the Youden index is 0.290,and the area under the curve is 0.625.The sensitivity of the prediction model is 55.7%,the specificity is 86.0%,the Youden index is 0.417,and the area under the curve is 0.740.Conclusion:Age,preoperative serum CEA,CA19-9 and alkaline phosphatase are independent risk factors of liver metastasis of colorectal cancer.The three laboratory indicators are of certain value for the screening of liver metastases of colorectal cancer and the evaluation of disease stage.The prediction model of three indicators combined with age detection has better prediction value for liver metastasis of colorectal cancer than single indicator detection,which is helpful for clinical prediction of liver metastasis of colorectal cancer.