2020 年第 12 期 第 15 卷

老年结直肠癌肺转移的CT诊断及危险因素分析

CT diagnosis and risk factors analysis of lung metastasis of colorectal cancer in the elderly

作者：梅勇1周志林1周红梅2魏柏3

英文作者：Mei Yong1 Zhou Zhilin1 Zhou Hongmei2 Wei Bai3

单位：1华中科技大学同济医学院附属梨园医院普通外科，武汉430077；2华中科技大学同济医学院附属梨园医院放射科，武汉430077；3华中科技大学同济医学院附属梨园医院肿瘤科，武汉430077

英文单位：1Department of General Surgery Liyuan Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430077 China; 2Department of Radiology Liyuan Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430077 China; 3Department of Oncology Liyuan Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430077 China

关键词：结直肠癌肺转移；CT诊断；危险因素

英文关键词：Lungmetastasisofcolorectalcancer;CTdiagnosis;RiskfactorsChina

• 摘要：

• 目的 探讨老年结直肠癌肺转移的危险因素及CT诊断在肺转移中的应用价值。方法 选择2016年1月至2019年1月在华中科技大学同济医学院附属梨园医院治疗的老年结直肠癌患者210例作为研究对象，根据是否发生肺转移分为肺转移组（48例）和对照组（162例）。所有患者均进行胸腹部CT增强扫描，观察结直肠癌肺转移患者的CT影像学特征。采用多因素Logistic回归方法分析影响老年结直肠癌肺转移的危险因素。调查因素包括性别、年龄、体重指数、吸烟史、原发肿瘤部位、肿瘤直径、原发灶病理类型、Dukes分期、脉管浸润和癌胚抗原。结果 210例老年结直肠癌患者中，合并肺转移48例，发生率为22.9%；肺转移CT征象多为单侧肺多发病灶，病灶形态以实性结节为主，病灶内部多呈均匀强化。单因素分析结果显示，2组原发肿瘤部位、原发灶病理类型、Dukes分期和癌胚抗原水平比较差异均有统计学意义（均P＜0.05）。多因素Logistic回归分析显示，原发肿瘤部位为直肠癌（比值比=4.491，95%置信区间：1.147～33.935，P=0.034）、原发灶病理类型为腺癌（比值比=6.367，95%置信区间：1.453～19.540，P=0.012）、Dukes分期C期（比值比=4.666，95%置信区间：1.176～28.375，P=0.031）、癌胚抗原水平升高（比值比=4.868，95%置信区间：1.213～26.327，P=0.027）是老年结直肠癌肺转移的危险因素。结论 老年结直肠癌肺转移CT表现多样，肺转移病灶多为单侧肺多发病灶，病灶形态以实性结节为主，病灶内部多呈均匀强化；直肠癌、腺癌、Dukes分期C期及癌胚抗原水平升高是影响结直肠癌肺转移的危险因素。

• Objective To investigate the CT diagnosis and risk factors of lung metastasis of colorectal cancer in the elderly. Methods Totally 210 elderly patients with colorectal cancer who were treated in Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2016 to January 2019 were selected. According to whether lung metastasis occurred, they were divided into lung metastasis group(48 cases) and control group(162 cases). All patients underwent thoracic and abdominal CT enhanced scanning to observe the CT imaging  characteristics of patients with lung metastasis of colorectal cancer. Single factor analysis was used to analyze the related factors of lung metastasis of colorectal cancer in the elderly. Multivariate Logistic regression was used to analyze the risk factors for lung metastasis of colorectal cancer in the elderly. The survey factors included gender, age, body mass index(BMI), smoking history, primary tumor location, tumor diameter, pathological type of primary tumor, Dukes stage, vascular invasion and carcinoembryonic antigen(CEA). Results Among 210 elderly patientns with colorectal cancer, 48 cases were associated with lung metastasis, the incidence was 22.9%; most of the CT signs of lung metastasis were unilateral multiple lung lesions, the focus shape was mainly solid nodule, and the inside of the focus was homogeneous enhancement. Univariate analysis showed  that there were significant differences in the location of primary tumor, pathological type of primary focus, Dukes stage and CEA level between the two groups (all P＜0.05). Multivariate logistic regression analysis showed that rectal cancer ［odds ratio(OR)=4.491, 95% confidence interval (CI): 1.147-33.935, P=0.034］, adenocarcinoma (OR=6.367, 95%CI: 1.453-19.540, P=0.012), Dukes stage C (OR=4.666, 95%CI: 1.176-28.375, P=0.031), increasing of CEA level (OR=4.868, 95%CI: 1.213-26.327, P=0.027) were risk factors for lung metastasis of colorectal cancer in the elderly. Conclusion sCT manifestations of elderly patients with lung metastasis of colorectal cancer are various, most of the lung metastases are unilateral multiple lung lesions, with solid nodules as the main lesions and homogeneous enhancement in the lesions. Rectal cancer, adenocarcinoma, Dukes stage C and elevated ECA level are the risk factors for lung metastasis of colorectal cancer.