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Analysis Of The Clinical Factors Of Hepatic Metastases Of Colorectal Cancer

Posted on:2011-12-03Degree:MasterType:Thesis
Country:ChinaCandidate:H M WangFull Text:PDF
GTID:2144360305954437Subject:Clinical Medicine
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Colorectal Cancer is one of common gastrointestinal malignant tumor. There is a growing tendency for the incidence and mortality of colorectal cancer in the world. Although there are no obvious symptoms of early colorectal cancer, but treatment Shique 15% ~ 35% of patients had metastasis, in which the liver is the most common and most important sites of metastases, the progress rate of patients with liver metastasis up to 50% ~ 70% about resectable 5-year survival was 11.5% ~ 45%, the average survival period of patients with conservative treatment, only 4 to 9 months, and therefore leading to colorectal cancer liver metastasis is an important reason for death in patients. Therefore, the availability of liver metastasis and prognosis of patients with adjuvant therapy decision-making are critical. In order to explore the liver metastasis in patients with clinical and pathological features, this study selected the Sino-Japanese Friendship Hospital, Jilin University in January 2006 -2,009 year in December more complete information treated by surgery and 305 cases of pathologically confirmed colorectal patients, 178 patients were men , and 127 were women, the ratio of male and female was 1.4:1. The age of all the patients ranged from 23 to 91 years old. The median age was 62 years old. The whole group had pathological liver metastasis were 99 cases, accounting for 32.46%. Youth were divided into groups by age (≤35 years old), middle-aged group (35-60 years) and elderly group (≥60 years). Divided according to duration of less than 1 year group and a group of more than one year. According to tumor location groups were divided into the rectum and colon group (sigmoid colon, ascending colon, transverse colon, descending colon, ileocecal). According to cell differentiation into well-differentiated group (well-differentiated adenocarcinoma and papillary adenocarcinoma), moderately differentiated group (moderately differentiated adenocarcinoma and mucinous adenocarcinoma), poorly differentiated group (poorly differentiated adenocarcinoma, signet-ring cell carcinoma and non - differentiated carcinoma). Divided according to the depth of myometrial invasion within the group, serous membrane layer, outside the group. On the availability of liver metastasis of colorectal cancer patients in gender, age, course of disease, tumor location, pathological type and degree of differentiation, depth of invasion, with or without history of hepatitis, lymph node metastasis, the availability of peritoneum and omentum metastatic nodules areas such as clinical and pathological features were analyzed.The result suggests: Whether patients with colorectal liver metastases gender, tumor location and whether the infection of hepatitis B virus, and so no significant difference in contrast. A total of 178 cases of men, accounting for 58.36%, than females (127 cases) slightly more. Men, 58 patients had liver metastases, accounting for 32.58%; female were 41 cases of liver metastases, accounting for 32.28%, no significant difference between the two. The whole group of 52 patients with duration of 12 months or more, 35 patients had a liver metastasis, while 253 cases of patients within 12 months of treatment, 64 cases of liver metastases appeared. Liver metastasis rates were 67.31%, 25.30%, compared with a statistically significant difference between the two groups (P <0.01). 305 cases of patients with mainly middle-aged, respectively, to 143 cases, 149 patients, and age≤35-year-olds only 13 cases, but appeared in eight cases of liver metastasis, metastasis rate was 61.54%, significantly higher than in the old age group 32.17%, 30.20%. Young adult group, green old age group with a statistically significant difference compared to (P <0.05, P <0.05), while the older group compared with no significant difference (P> 0.05). Cancer patients in this group occurred in the rectum were 174 cases, 57 cases (32.76%) were metastatic; tumors occur in the colon were 131 cases (49 patients with sigmoid colon cancer, liver metastasis rate was 30.61%; l 43 cases of colon cancer, metastasis rate was 30.23%; transverse colon in 12 cases, the transfer rate was 34.33%; descending colon in 18 cases, the transfer rate was 33.33%; ileocecal colon cancer in 9 cases, the transfer rate was 33.33%) in the liver metastasis were 42 cases, accounting for 42.42%, colon slightly higher than the rate of rectal cancer liver metastases, but no statistical significance between the two (P> 0.05). Differentiation of tumor cells is different ,from the chances of liver metastasis is also significantly different, this group of patients with postoperative pathology revealed poorly differentiated in the main, were 187 cases, 99 cases were poorly differentiated readily from liver metastasis, metastasis rate was 57.58% (57/99), significantly higher than that in well-differentiated group (20.86%, 15.79%), three statistically significant difference compared to (P <0.01), but in well-differentiated between the two groups was no significant difference (P> 0.05). Pathological tumor cell infiltration of the depth of the intestinal wall, the chances of liver metastasis also obviously different from full-thickness infiltration of the intestinal wall and beyond those of full-thickness infiltration of liver metastasis was significantly higher than a mere muscle or muscle were not reached, the whole group 229 cases of patients with pathological infiltration of the intestinal wall, or up to full-thickness serosa outside groups, which appeared in 91 cases of liver metastasis, metastasis rate was 39.74%, while the tumors were confined to muscle within the 76 patients only 8 cases the hepatic metastasis, metastasis rate was 10.53%. Compared the two groups was statistically significant (P <0.01). This group of 305 cases of colorectal cancer patients, hepatitis B virus infection in 21 patients, 8 patients had liver metastasis, metastasis rate was 38.10%, non-group of 284 cases of hepatitis B virus infection in 91 patients with liver metastasis, metastasis rate was 32.04%. Hepatitis B virus infection group, slightly higher than the rate of liver metastasis of non-hepatitis B virus infection, but no significant difference between the two groups (P> 0.05). According to the report after pathological lymph node metastasis is different, the probability of liver metastasis was significantly different, with lymph node metastasis of liver metastasis was significantly higher than those without lymph node metastasis, and with the increase in the number of lymph node metastasis, liver metastasis rate also increased. 305 cases of this group of patients, 118 patients, there is regional lymph node metastasis, liver metastasis in 58 cases, the transfer rate of 49.15%; 187 cases of patients without regional lymph node metastasis, liver metastasis in 41 cases, the transfer rate of 21.93%. Regional lymph node metastasis in four or four over 42 patients with lymph node metastasis, liver metastasis in 26 cases, the transfer rate of 61.90%, significantly higher than 1 to 3 lymph node metastasis (liver metastasis rate was 42.11%) and without lymph node metastasis group (liver metastasis rate was 21.93%), the difference was statistically significant (P <0.01). This group of 305 cases of colorectal cancer patients, intraoperative exploration found in the pelvic peritoneum or omentum are 33 cases of patients with metastatic nodules, 25 cases of liver metastasis, metastasis rate was 75.76%; group of 272 cases of non-metastatic nodules, liver metastasis 74 cases, transfer rate of 27.21%. There peritoneum and omentum metastatic nodules of the liver metastasis group was significantly higher than those without metastatic nodules group, two groups was statistically significant (P <0.01). There are many factors relating to hepatic metastasis. The Cox multivariate regression analysis showed liver metastasis and tumor cell differentiation, tumor invasion depth, lymph node metastasis, peritoneal and omental metastatic nodules related to ,rule out the age, duration factors.To sum up, Colorectal liver metastasis and patient's sex, tumor site, infected with hepatitis B virus has nothing to do; with the patient the course of diseases, duration 1 year or more readily from liver metastasis; with the patient age-related, easy to occur in patients under the age of 35, liver metastasis; with the pathologic type and degree of cell differentiation, poorly differentiated adenocarcinoma, signet-ring cell carcinoma, undifferentiated carcinoma and poorly differentiated tumor cells were readily from liver metastasis; and the depth of tumor cell invasion, invasion of full-thickness and full thickness than those who myometrial invasion to the liver metastasis was higher than within persons; With regional lymph node metastasis, lymph node metastasis, liver metastasis prone, and the more the number of lymph node metastasis, liver metastasis incidence is higher; Peritoneal and omental metastatic nodules on, there are peritoneal and omental metastatic nodules are easy to occur hepatic metastases.
Keywords/Search Tags:colorectal cancer, hepatic metastases, clinical correlation factors
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