[1]刘珣 温越 李军 顾芳 丁士刚*.早期结直肠癌与Ⅲ级腺瘤临床、内镜特征的多因素分析[J].中国微创外科杂志,2023,01(3):167-172.
　Liu Xun,Wen Yue,Li Jun,et al.Multivariate Analysis of Clinical and Endoscopic Features of Early Colorectal Cancer and Grade Ⅲ Adenoma[J].Chinese Journal of Minimally Invasive Surgery,2023,01(3):167-172.
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早期结直肠癌与Ⅲ级腺瘤临床、内镜特征的多因素分析()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2023年3期
页码:
167-172
栏目:
临床论著
出版日期:
2023-03-25

文章信息/Info

Title:
Multivariate Analysis of Clinical and Endoscopic Features of Early Colorectal Cancer and Grade Ⅲ Adenoma
作者:
刘珣 温越 李军 顾芳 丁士刚*
(北京大学第三医院消化科，北京100191)
Author(s):
Liu Xun;  Wen Yue;  Li Jun;  et al.
Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
关键词:
早期结直肠癌; 结直肠腺瘤; 临床特征; 内镜特征
Keywords:
Early colorectal cancer; Colorectal adenoma; Clinical feature; Endoscopic feature
文献标志码:
A
摘要:
目的探讨早期结直肠癌和结直肠Ⅲ级腺瘤的临床、内镜特征。方法回顾性分析2015年3月~2018年8月177例早期结直肠癌及85例结直肠Ⅲ级腺瘤患者资料，对其临床、内镜特征进行多因素分析。结果症状方面，早期结直肠癌里急后重多［5.1%(9/177) vs. 0%(0/85)，P=0.034］，大便潜血阳性多［49.7%(88/177) vs. 29.4%(25/85)， χ2=9653，P=0.002］。内镜特征方面，早期结直肠癌内镜下长径>15 mm多［66.1%(117/177) vs. 43.5%(37/85)， χ2=12075，P=0.001］，位于直肠多［31.1%(55/177) vs. 17.6%(15/85)， χ2=5.287，P=0.021］，黏膜不光滑(粗糙或绒毛感)多［37.3%(66/177) vs. 22.4%(19/85)， χ2=5.844，P=0.016］，根部白斑多［17.5%(31/177) vs. 8.2%(7/85)， χ2=3.987，P=0046］。多因素logistic回归分析显示大便潜血阳性(OR=2.141，95% CI：1.199~3.824，P=0.010)，内镜下长径>15 mm(OR=2.025，95% CI：1.147~3.576，P=0.015)是早期结直肠癌的独立影响因素。长径≤15 mm的早期结直肠癌和Ⅲ级腺瘤的临床及内镜特征中，多因素logistic回归分析显示年龄≥55岁(OR=3.228，95% CI：1.076~9.683，P=0.036)，贫血(OR=12.368，95% CI：1.396~109.565，P=0.024)，位于直肠(OR=3.300，95% CI：1.055~10.329，P=0.040)，根部白斑(OR=9299，95% CI：1.695~51.022，P=0.010)是长径≤15 mm早期结直肠癌的独立影响因素。结论相较于Ⅲ级腺瘤，早期结直肠癌更多出现大便潜血阳性，且病变内镜下长径>15 mm的占比更高。对于较小(长径≤15 mm)的病变，如果患者年龄≥55岁，出现贫血，病变位于直肠或发生根部白斑，则需要警惕早期结直肠癌的可能。
Abstract:
ObjectiveTo investigate the clinical and endoscopic features of early colorectal cancer and grade Ⅲ adenoma.MethodsA total of 177 patients with early colorectal cancer and 85 patients with grade Ⅲ colorectal adenoma from March 2015 to August 2018 were retrospectively analyzed, and multivariate analysis of clinical and endoscopic features was carried out.ResultsIn terms of symptoms, there were more tenesmus ［5.1% (9/177) vs. 0% (0/85), P=0.034］ and more positive fecal occult blood ［49.7% (88/177) vs. 29.4% (25/85), χ2=9.653, P=0.002］ in early colorectal cancer patients. In terms of endoscopic features, there were more cases with long diameter > 15 mm under endoscopy ［66.1% (117/177) vs. 43.5% (37/85), χ2=12075, P=0.001］, more cases located in the rectum ［31.1% (55/177) vs. 17.6% (15/85), χ2=5.287, P=0.021］, more cases with nonsmooth mucous membranes (rough or villous feeling) ［37.3% (66/177) vs. 22.4% (19/85), χ2=5.844, P=0016］, and more root leukoplakia ［17.5% (31/177) vs. 8.2% (7/85), χ2=3.987, P=0.046］ in early colorectal cancer patients. Multivariate logistic regression analysis showed that positive fecal occult blood (OR=2.141, 95% CI: 1.199-3.824, P=0.010) and long diameter >15 mm of the lesions (OR=2.025, 95% CI: 1.147-3.576, P=0.015) were independent influencing factors of early colorectal cancer. For clinical and endoscopic features of early colorectal cancer and grade Ⅲ adenoma with long diameter ≤ 15 mm, multivariate logistic regression analysis showed that age ≥ 55 years old (OR=3.228, 95% CI: 1.076-9.683, P=0.036), anemia (OR=12.368, 95% CI: 1.396-109.565, P=0.024), located in the rectum (OR=3.300, 95% CI: 1.055-10.329, P=0.040), and root leucoplakia (OR=9.299, 95% CI: 1.695-51.022, P=0.010) were independent influencing factors of early colorectal cancer.ConclusionsCompared with the grade Ⅲ adenoma, there were more positive fecal occult blood and a higher proportion of lesions with long diameter >15 mm in early colorectal cancer. For small lesions (long diameter ≤15 mm), if the patient is more than 55 years old, has anemia, develops lesion located in the rectum, or has root leukoplakia, it is necessary to be alert to the possibility of early colorectal cancer.

参考文献/References:

[1]兰琴,魏玉霞.影响结肠腺瘤发病的危险因素及预防术后复发研究进展.中国中西医结合消化杂志,2021,29(8):595-598.
[2]郑荣寿，孙可欣，张思维,等.2015年中国恶性肿瘤流行情况分析.中华肿瘤杂志，2019，41(1):19-28.
[3]国家癌症中心中国结直肠癌筛查与早诊早治指南制定专家组.中国结直肠癌筛查与早诊早治指南.中华肿瘤杂志,2021,43(1):16-38.
[4]李鹏，王拥军,陈光勇,等.中国早期结直肠癌及癌前病变筛查与诊治共识.中国实用内科杂志，2015,35(3):211-227.
[5]王玉富,王伟强,范占东,等.结肠镜检查者临床症状对结直肠息肉和癌的提示作用.胃肠病学,2015,20(10):612-615.
[6]Dekker E,Tanis PJ,Vleugels JLA,et al.Colorectal cancer.Lancet,2019,394(10207):1467-1480
[7]苏莎莎,孔文洁,赫晓磊,等.909例新疆维吾尔族结直肠腺瘤及结直肠早癌相关危险因素分析.中华结直肠疾病电子杂志,2017,6(5):402-406.
[8]Zhang QL,Zhao LG,Li HL,et al.The joint effects of major lifestyle factors on colorectal cancer risk among Chinese men:a prospective cohort study.Int J Cancer,2018,142(6):1093-1101.
[9]McNabb S,Harrison TA,Albanes D,et al.Metaanalysis of 16 studies of the association of alcohol with colorectal cancer.Int J Cancer,2020,146(3):861-873.

备注/Memo

备注/Memo:
*通讯作者，Email：dingshigang222@163.com
更新日期/Last Update: 2023-06-23