背景:晚期直肠癌肠系膜下淋巴结转移是晚期直肠癌的常见并发症,对患者的治疗和预后有重要影响。
目的:探讨直肠癌肠系膜下动脉(IMA)根部淋巴结转移的临床病理特点。这项研究的结果为我们提供了新的医学信息,帮助我们确定这些患者的适当治疗方法。
方法:我们的研究搜索了PubMed,谷歌学者,和其他数据库,并检索了截至2023年12月31日在自建数据库中发表的关于直肠癌IMA根部淋巴结转移危险因素的相关研究和报告。数据提取后,纽卡斯尔-渥太华量表用于评价纳入文献的质量,采用RevMan5.3软件进行Meta分析和异质性检验。选择没有异质性的固定效果模块来组合效果大小,选择具有异质性的随机效应模块来组合效应大小。通过敏感性分析发现异质性的原因,并将各种风险因素的数据进行组合以获得最终的影响大小,比值比(OR)值,95%置信区间(CI)。通过绘制漏斗图测试出版偏差。
结果:本研究共纳入7篇文献。通过结合logistic多变量回归的OR值和各种危险因素的95CI,我们得出结论,直肠癌IMA区淋巴结转移的危险因素如下:术前癌胚抗原(CEA)>5ng/mL(OR=0.32,95CI:0.18-0.55,P<0.05)。肿瘤位于腹膜反射以上(OR=3.10,95CI:1.78-5.42,P<0.05),肿瘤大小≥5cm(OR=0.36,95CI:0.22~0.57,P<0.05),病理类型(黏液腺癌/生环细胞癌)(OR=0.23,95CI:0.13-0.41,P<0.05),肿瘤分化程度(低分化)(OR=0.17,95CI:0.10-0.31,P<0.05),肿瘤分期(T3-4分期)(OR=0.11,95CI:0.04-0.26,P<0.05),性别和年龄不是直肠癌IMA根部淋巴结转移的危险因素(P>0.05)。
结论:术前CEA水平,肿瘤位置,肿瘤大小,肿瘤病理类型,肿瘤分化,T分期与IMA根部淋巴结转移相关。
BACKGROUND: Advanced rectal cancer with submesenteric lymph node metastasis is a common complication of advanced rectal cancer, which has an important impact on the treatment and prognosis of patients.
OBJECTIVE: To investigate the clinical and pathological characteristics of inferior mesenteric artery (IMA) root lymph node metastases in patients with rectal cancer. The findings of this study provided us with fresh medical information that assisted us in determining the appropriate treatment for these patients.
METHODS: Our study searched PubMed, Google Scholar, and other databases and searched the relevant studies and reports on the risk factors of IMA root lymph node metastasis of rectal cancer published in the self-built database until December 31, 2023. After data extraction, the Newcastle-Ottawa scale was used to evaluate the quality of the included literature, and RevMan5.3 software was used for meta-analysis and heterogeneity testing. The fixed effect modules without heterogeneity were selected to combine the effect size, and the random effect modules with heterogeneity were selected to combine the effect size. The cause of heterogeneity was found through sensitivity analysis, and the data of various risk factors were combined to obtain the final effect size, odds ratio (OR) value, and 95% confidence interval (CI). Publication bias was tested by drawing funnel plots.
RESULTS: A total of seven literature were included in this study. By combining the OR value of logistic multivariate regression and the 95%CI of various risk factors, we concluded that the risk factors for lymph node metastasis in the IMA region of rectal cancer were as follows: Preoperative carcinoembryonic antigen (CEA) > 5 ng/mL (OR = 0.32, 95%CI: 0.18-0.55, P < 0.05), tumor located above peritoneal reflexive (OR = 3.10, 95%CI: 1.78-5.42, P < 0.05), tumor size ≥ 5 cm (OR = 0.36, 95%CI: 0.22-0.57, P < 0.05), pathological type (mucinous adenocarcinoma/sig-ring cell carcinoma) (OR = 0.23, 95%CI: 0.13-0.41, P < 0.05), degree of tumor differentiation (low differentiation) (OR = 0.17, 95%CI: 0.10-0.31, P < 0.05), tumor stage (T3-4 stage) (OR = 0.11, 95%CI: 0.04-0.26, P < 0.05), gender and age were not risk factors for IMA root lymph node metastasis in rectal cancer (P > 0.05).
CONCLUSIONS: Preoperative CEA level, tumor location, tumor size, tumor pathologic type, tumor differentiation, and T stage were correlated with IMA root lymph node metastasis.