临床肿瘤学杂志

目的 探讨结差分化细胞群(PDCs)与直肠癌患者根治术后发生隐匿性肝转移的关系。方法 回顾性分析2020年7月至2022年7月在张家口市第一医院接受结直肠癌根治术患者的临床病历资料，共纳入185例。采用病理HE染色检测患者的PDCs分级，分析PDCs分级与结直肠癌临床病理特征的关系。术后随访12～36个月，根据是否发生隐匿肝转移分为转移组(n=46)和未转移组(n=139),比较两组临床资料，采用Logistic回归模型分析影响结直肠癌术后发生隐匿性肝转移的危险因素。结果 185例结直肠癌组织中G1级37例、G2级78例和G3级70例。PDCs级别与性别、年龄、肿瘤直径、肿瘤位置、有无腹腔积液及有无肠穿孔等均无关(P>0.05);PDCs级别与周围神经侵犯、淋巴结转移、分化程度、血管侵犯和病理T分期等均有关(P<0.05)。转移组患者肿瘤直径≥5 cm、有周围神经侵犯、有淋巴结转移、低分化程度、有血管侵犯、T_3-4期及PDCs级别G3级比例高于未转移组，差异有统计学意义(P<0.05)。多因素Logistic回归模型结果显示，淋巴结转移、血管侵犯、周围神经侵犯和PDCs级别是影响患者发生隐匿性肝转移的危险因素(P<0.05)。结论 结直肠癌组织中PDCs分级与周围神经侵犯、淋巴结转移、分化程度、血管侵犯和病理T分期有关，且有淋巴结转移、血管侵犯、周围神经侵犯和PDCs级别G3级是影响结直肠癌患者发生隐匿性肝转移的危险因素。

Objective To investigate the relationship between poorly differentiated cell populations(PDCs) in colorectal cancer and the occurrence of occult liver metastasis in patients after radical surgery. Methods The clinical medical records of 185 patients who received radical resection of colorectal cancer in Zhangjiakou First Hospital from July 2020 to July 2022 were retrospectively analyzed. The PDCs grade was detected by pathological HE staining, and the relationship between PDCs grade and clinicopathological features was analyzed. After 12 to 36 months of postoperative follow-up, patients were divided into metastatic group(n=46) and non-metastatic group(n=139) according to whether occult liver metastasis occurred. The clinical data of the two groups were compared, and the risk factors of occult liver metastasis after colorectal cancer surgery were analyzed by Logistic regression model. Results PDCs grade in colorectal cancer tissues was not correlated with gender, age, tumor diameter, tumor location, abdominal fluid and intestinal perforation(P>0.05), while PDCs grade was correlated with peripheral nerve invasion, lymph node metastasis, differentiation degree, vascular invasion and pathological T stage(P<0.05). The proportion of patients with tumor diameter ≥5 cm, peripheral nerve invasion, lymph node metastasis, low differentiation, vascular invasion, stage T_3-4 and PDCs grade G3 in metastatic group was higher than that in non-metastatic group, with statistical significance(P<0.05). The results of multivariate Logistic regression model showed that lymph node metastasis, vascular invasion, peripheral nerve invasion and PDCs grade were the risk factors for occulting liver metastasis in patients(P<0.05). Conclusion The grade of PDCs in colorectal cancer tissues is related to peripheral nerve invasion, lymph node metastasis, differentiation degree, vascular invasion and pathological T stage, and lymph node metastasis, vascular invasion, peripheral nerve invasion and PDCs grade G3 are risk factors for occult liver metastasis in colorectal cancer patients.