低铁状态与结直肠腺癌患者临床特征的相关性研究
Correlation Analysis between Low Iron Status and Clinical Characteristics of Colorectal Cancer Catients
骆浩 1罗雅军 2杨一 1胡海2
作者信息
- 1. 611137 四川省成都市，成都中医药大学医学与生命科学学院
- 2. 610041 四川省成都市，四川省肿瘤医院大肠外科
- 折叠
摘要
背景 结直肠癌是全球发病率排名第二的恶性肿瘤。研究表明，铁代谢参与肿瘤细胞增殖及免疫微环境调节等多个肿瘤进展环节，临床中结直肠癌患者多伴随血清铁状态异常，其中血清铁水平较低更为常见。探讨低铁状态与结直肠癌的相关性，对结直肠癌的个体化治疗具有重要意义。目的 本研究旨在全面、系统地探讨结直腺癌患者内环境低铁状态与多种临床特征的关系。方法 本研究基于单中心登记的回顾性队列研究，连续纳入四川省肿瘤医院2017年1月—2023年6月712例术后病理确诊为结直肠腺癌的患者为研究对象，收集血清铁、转铁蛋白饱和度及各项临床特征指标，根据术前血清铁的表达水平将患者分为低铁状态组（低铁组，n=363）和铁状态正常的对照组（n=349）。采用倾向性评分匹配（PSM）对患者进行1∶1匹配，卡尺设置为0.2，最终纳入匹配后样本698例（低铁组与对照组各349例）。采用单因素分析和多因素Logistic回归分析探讨低铁状态与临床特征相关性。结果 712例患者中363例（50.98%）处于内环境低铁状态。PSM匹配前，对照组和低铁组美国麻醉医师协会分级（ASA）、癌梗阻比例、贫血比例比较，差异有统计学意义（P<0.05）；PSM匹配后，两组ASA、癌梗阻比例、贫血比例比较，差异仍有统计学意义（P<0.05）。PSM匹配后低铁状态组白细胞计数（WBC）、C反应蛋白（CRP）、血小板压积（PCT）及癌胚抗原（CEA）表达水平高于对照组，淋巴细胞计数（LY）、白蛋白（ALB）与血清总胆固醇（TC）水平低于对照组（P<0.05）。两组肿瘤位置、国际抗癌联盟（UICC）TNM分期、病理类型、分化程度、错配修复表达（MMR）状态、微卫星稳定状态、神经及脉管侵犯、肝及肺转移比率、肿瘤长径比较，差异有统计学意义（P<0.05）。采用PSM控制基线混杂因素后，将贫血作为一个独立预测变量分离进行多因素Logistic回归分析显示未纳入贫血时肿瘤部位（直肠，OR=0.410，95%CI=0.25~0.67，P<0.01）、UICC Ⅳ期（OR=3.50，95%CI=1.65~7.82，P<0.01）、脉管侵犯（OR=1.63，95%CI=1.01~2.63，P=0.04）、肿瘤长径（OR=1.16，95%CI=1.03~1.30，P<0.01）、ALB（OR=0.90，95%CI=0.85~0.95，P<0.01）及PCT（OR=1.12，95%CI=1.08~1.15，P<0.01）、LY（OR=0.51，95%CI=0.35~0.72，P<0.01）是结直肠腺癌患者低铁状态的独立影响因。纳入贫血后多因素Logistic回归分析显示贫血（OR=7.03，95%CI=4.40~11.25，P<0.01）成为低铁状态独立影响因素，而肿瘤部位不再是独立影响因素，余肿瘤长径、UICC Ⅳ期、脉管侵犯以及外周血LY、PCT、ALB仍为结直肠腺癌患者低铁状态的独立相关因素（P<0.05）。结论 结直肠腺癌患者内环境铁状态与肿瘤侵袭性（分期、神经脉管侵犯、肿瘤长径）及炎症指标密切相关。直肠与较高水平的ALB及LY是结直肠腺癌患者低铁状态的保护因素，贫血、UICC Ⅳ期、脉管侵犯、较大的肿瘤长径及PCT是低铁状态的危险因素。
Abstract
BackgroundColorectal cancerCRCis the second most common malignant tumor in terms of incidence worldwide. Studies have shown that iron metabolism is involved in multiple aspects of tumor progressionsuch as tumor cell proliferation and immune microenvironment regulation. Clinicallymost CRC patients are accompanied by abnormal serum iron statusamong which low serum iron levels are more common. Exploring the correlation between low iron status and colorectal cancer is of great significance for the individualized treatment of colorectal cancer. ObjectiveThis study aims to comprehensively and systematically investigate the relationship between the internal environment low iron status and various clinical characteristics in patients with colorectal adenocarcinoma. MethodsBased on a single-center registered retrospective cohort study712 patients who were pathologically diagnosed with colorectal adenocarcinoma after surgery at Sichuan Cancer Hospital from January 2017 to June 2023 were consecutively included as research subjects. Indicators including serum irontransferrin saturationand various clinical characteristics were collected. Patients were divided into the low iron status grouplow iron groupn=363and the control group with normal iron statusn=349according to the preoperative serum iron expression level. Propensity score matchingPSMwas used for 11 matching of patientswith a caliper set at 0.2. Finally698 matched samples were included 349 cases in both the low iron group and the control group. Univariate analysis and multivariate Logistic regression analysis were used to explore the correlation between low iron status and clinical characteristics. ResultsAmong the 712 patients363 cases50.98%had low iron status in the internal environment. Before PSM matchingthere were statistically significant differences between the control group and the low iron group in the American Society of AnesthesiologistsASAclassificationthe proportion of cancer obstructionand the proportion of anemiaP<0.05after PSM matchingthe differences in ASA classificationthe proportion of cancer obstructionand the proportion of anemia between the two groups were still statistically significantP<0.05. After PSM matchingthe expression levels of white blood cell countWBCC-reactive proteinCRPplateletcritPCTand carcinoembryonic antigenCEAin the low iron status group were higher than those in the control groupwhile the levels of lymphocyte countLYalbuminALBand serum total cholesterolTCwere lower than those in the control groupP<0.05. There were statistically significant differences between the two groups in tumor locationInternational Union Against CancerUICCTNM stagepathological typedegree of differentiationmismatch repairMMRexpression statusmicrosatellite stability statusnerve and vascular invasionliver and lung metastasis ratesand tumor length P<0.05. After controlling for baseline confounding factors using PSManemia was separated as an independent predictive variable for multivariate Logistic regression analysis. The results showed that when anemia was not includedtumor locationrectumOR=0.41095%CI=0.25-0.67P<0.01UICC stage OR=3.5095%CI=1.65-7.82P<0.01vascular invasionOR=1.6395%CI=1.01-2.63P=0.04tumor lengthOR=1.1695%CI=1.03-1.30P<0.01ALBOR=0.9095%CI=0.85-0.95P<0.01PCTOR=1.1295%CI=1.08-1.15P<0.01and LYOR=0.5195%CI=0.35-0.72P<0.01were independent influencing factors for low iron status in patients with colorectal adenocarcinoma. When anemia was included in the multivariate Logistic regression analysisanemiaOR=7.0395%CI=4.40-11.25P<0.01became an independent influencing factor for low iron statuswhile tumor location was no longer an independent influencing factor. The remaining factorsincluding tumor lengthUICC stage vascular invasionand peripheral blood LYPCTand ALBwere still independent factors associated with low iron status in patients with colorectal adenocarcinomaP<0.05. ConclusionThe internal environment iron status of patients with colorectal adenocarcinoma is closely associated with tumor invasivenessincluding tumor stageneurovascular invasionand tumor lengthas well as inflammatory indicators. Rectal tumor locationalong with higher levels of albuminALBand lymphocyte countLYare protective factors against low iron status in patients with colorectal adenocarcinoma. In contrastanemiaUICC stage vascular invasionlonger tumor lengthand higher plateletcritPCTare risk factors for low iron status.关键词
结直肠肿瘤/结直肠腺癌/肿瘤微环境/内环境铁/低铁状态引用本文复制引用
骆浩,罗雅军,杨一,胡海.低铁状态与结直肠腺癌患者临床特征的相关性研究[EB/OL].(2025-11-10)[2026-04-03].https://chinaxiv.org/abs/202511.00072.学科分类
临床医学/肿瘤学/医学研究方法
评论