同时性结直肠癌肝转移的临床病理特征及影响因素分析
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1江汉大学附属湖北省第三人民医院 药学部,湖北 武汉 430000;2中南大学湘雅医院 胃肠外科,湖南 长沙 410008;3中南大学湘雅医院 药学部,湖南 长沙 410008;4中南大学湘雅医院 国家老年疾病临床医学研究中心,湖南 长沙 410008

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李旷宇,江汉大学附属湖北省第三人民医院主管药师,主要从事肿瘤临床药学与营养方面的研究。

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Clinicopathologic characteristics and factors associated with synchronous liver metastasis in colorectal cancer
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1Department of Pharmacy, Hubei No.3 People's Hospital of Jianghan University, Wuhan 430000, China;2Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha 410008, China;3Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410008, China;4National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha 410008, China

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    摘要:

    背景与目的 同时性肝转移是影响结直肠癌患者治疗策略及预后的重要因素,识别初诊时发生肝转移的高危因素有助于优化风险分层和诊疗决策。本研究分析同时性结直肠癌肝转移患者的临床病理及分子特征,探讨其发生的独立影响因素。方法 回顾性收集2016年1月1日—2023年12月31日于中南大学湘雅医院诊治的373例结直肠癌患者的临床资料。根据首诊时是否存在肝转移分为肝转移组和无肝转移组。比较两组患者临床病理特征、肿瘤标志物及KRAS、NRAS、BRAFV600E和微卫星不稳定性(MSI)等分子特征的差异,采用Firth惩罚Logistic回归模型分析同时性肝转移的独立影响因素。结果 373例患者中92例(24.66%)发生同时性肝转移。单因素分析显示,肿瘤部位、淋巴转移、肝外远处转移、癌胚抗原(CEA)、糖类抗原19-9(CA19-9)及MSI状态与同时性肝转移相关(均P<0.05)。多因素Firth回归分析显示,淋巴转移(OR=2.828,95% CI=1.346~6.489,P=0.005)、肝外远处转移(OR=2.243,95% CI=1.176~4.279,P=0.014)和CEA阳性(OR=4.519,95% CI=2.537~8.262,P<0.001)是同时性肝转移的独立危险因素;直肠原发肿瘤(OR=0.491,95% CI=0.278~0.852,P=0.011)和MSI(OR=0.112,95% CI=0.001~0.917,P=0.039)与较低的同时性肝转移风险独立相关。结论 肿瘤部位、淋巴结转移、肝外远处转移及CEA阳性与同时性结直肠癌肝转移风险增加独立相关,而直肠原发肿瘤和MSI与较低的肝转移风险相关。上述临床病理及分子特征有望用于初诊结直肠癌患者的肝转移风险分层,并为进一步的肝脏影像学评估和个体化诊疗提供参考。

    Abstract:

    Background and Aims Synchronous liver metastasis is an important determinant of treatment strategy and prognosis in patients with colorectal cancer. Identifying patients at high risk of liver metastasis at initial diagnosis may facilitate risk stratification and individualized management. This study aimed to characterize the clinicopathological and molecular features of synchronous colorectal liver metastasis and to identify its independent associated factors.Methods The clinical data from 373 patients with colorectal cancer who were treated at Xiangya Hospital, Central South University, between January 1, 2016 and December 31, 2023, were retrospectively collected. Patients were divided into a liver metastasis group and a non-liver metastasis group according to the presence of liver metastasis at initial diagnosis. Clinicopathologic characteristics, tumor markers, and molecular features, including KRAS, NRAS, BRAFV600E, and microsatellite instability (MSI) status, were compared between the two groups. Firth penalized Logistic regression was performed to identify independent factors associated with synchronous liver metastasis.Results Among the 373 patients, 92 (24.66%) had synchronous liver metastasis. Univariate analysis showed that tumor location, lymph node metastasis, extrahepatic distant metastasis, carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and MSI status were associated with synchronous liver metastasis (all P<0.05). Multivariate Firth regression analysis identified lymph node metastasis (OR=2.828, 95% CI=1.346-6.489, P=0.005), extrahepatic distant metastasis (OR=2.243, 95% CI=1.176-4.279, P=0.014), and positive CEA (OR=4.519, 95% CI=2.537-8.262, P<0.001) as independent risk factors. Rectal primary tumor (OR=0.491, 95% CI=0.278-0.852, P=0.011) and MSI (OR=0.112, 95% CI=0.001-0.917, P=0.039) were independently associated with a lower risk of synchronous liver metastasis.Conclusion Tumor location lymph node metastasis, extrahepatic distant metastasis, and positive CEA were independently associated with an increased risk of synchronous liver metastasis, whereas rectal primary tumor and MSI were associated with a lower risk. These clinicopathological and molecular characteristics may help stratify the risk of synchronous liver metastasis in patients with newly diagnosed colorectal cancer and may provide a basis for further hepatic imaging evaluation and individualized management.

    图1 多因素Firth回归森林图(OR>1提示该因素增加肝转移风险,OR<1提示该因素降低肝转移风险;水平线段表示95% CI的范围)Fig.1 Forest plot of multivariate Firth regression analysis of factors associated with synchronous liver metastasis in colorectal cancer (an OR>1 indicates an increased risk of liver metastasis, whereas an OR<1 indicates a decreased risk; horizontal line segments represent the 95% CIs)
    表 1 肝转移与无肝转移结直肠癌患者基线特征的比较[n(%)]Table 1 Comparison of baseline characteristics between colorectal cancer patients with and without liver metastasis [n (%)]
    表 2 肝转移与无肝转移结直肠癌患者临床病理特征及分子特征的比较[n(%)]Table 2 Comparison of clinicopathologic and molecular characteristics between colorectal cancer patients with and without liver metastasis [n (%)]
    表 3 同时性结直肠癌肝转移的单因素Firth回归分析Table 3 Univariate Firth regression analysis of factors associated with synchronous liver metastasis in colorectal cancer
    表 4 同时性结直肠癌肝转移的多因素Firth回归分析Table 4 Multivariate Firth regression analysis of factors associated with synchronous liver metastasis in colorectal cancer
    表 5 Table 5
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李旷宇,葛杰,康庭恺,康阔,唐密密,刘合利.同时性结直肠癌肝转移的临床病理特征及影响因素分析[J].中国普通外科杂志,2026,35(7):1388-1396.
DOI:10.7659/j. issn.1005-6947.260152

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  • 收稿日期:2026-03-29
  • 最后修改日期:2026-07-23
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  • 在线发布日期: 2026-08-31
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