임상 및 병리조직학적 특징에 따른 대장암의 간전이율
Prevalence of Liver Metastasis of Colorectal Cancer According to Clinical and Histopathologic Characteristics
류동원, 이승현, 안병권, 백승언,
소속 상세정보
류동원 ( Ryu Dong-Won )
고신대학교 복음병원 외과학교실
이승현 ( Lee Seung-Hyun )
고신대학교 복음병원 외과학교실
안병권 ( Ahn Byung-Kwon )
고신대학교 복음병원 외과학교실
백승언 ( Baek Sung-Uhn )
고신대학교 복음병원 외과학교실
KMID : 0356720020180040246
Abstract
Purpose: In Korea, the incidence of colorectal cancer is increasing quickly. The liver metastasis is the most common cause of death. But current diagnosis methods such as CT, MRI, USG have significant false negative rate (up to 15%) especially in micrometastasis. We designed this study to identify the predictive value of liver metastasis of known clinical and histopathologic factors.
Methods: Retrospectively, we reviewed 248 patients who underwent resection of colorectal cancer between 1997 and 1999. Clinical and histopathologic factors of colorectal cancer with synchronous liver metastasis was compared with those without liver metastasis.
Results: Twenty-nine patients had synchronous liver metastasis. In clinical factors, there was significant difference in liver metastatic rate according to tumors location, and serum carcinoembryonic antigen (CEA). The metastatic rate of right colon was 9.5%, left colon was 27.9%, rectum was 8.0% (P=0.001). The metastatic rate in cases with CEA＜5.0 ng/㎖ was 4.3%, CEA≥5.0 ng/㎖ was 18.4% (P=0.001). In histopathologic factors, there was significant difference in liver metastatic rate according to depth of tumor invasion (T-stage), extent of lymph node metastasis (N-stage), venous invasion (9.5 vs 19.3 %, P=0.043), perineural invasion (8.5 vs 19.7 %, P=0.013). The metastatic rate of T1 was 0%, T2 was 3.43%, T3 was 12.3%, T4 was 26.9% (P=0.009). The metastatic rate of N0 was 4.9%, N1 was 15.6%, N2 was 30.3% (P=0.002). But there was no significant difference according to tumor size, histologic differentiation grade, lymphatic invasion. In multi-variant analysis with significant factors, independent factor associated with liver metastasis was N-stage.
Conclusions: In colorectal cancer, tumor location, CEA, T-stage, N-stage, venous invasion, and perineural invasion of tumor cell had significant relationship with liver metastasis. The most important factor associated with liver metastasis was N-stage. This factors shoud be considered carefully in the planning treatment and follow up in colorectal cancer.
키워드
대장암;간전이;림프절 전이
Colorectal cancer;Liver metastasis;Lymph node metastasis
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