Background:Distant metastasis is the leading cause of death in patients with rectal cancer. This study aims to comprehensively analyze the risk factors of distant metastasis in T3 T4 rectal cancer using magnetic resonance imaging (MRI), pathological features, and serum indicators.Methods:The clinicopathological data of 146 cases of T3 T4 rectal cancer after radical resection from January 2015 to March 2023 were retrospectively analyzed. Pre- and postoperative follow-up data of all cases were collected to screen for distant metastatic lesions. Univariate and multivariate Logistic regression methods were used to analyze the relationship between MRI features, pathological results, serum test indexes, and distant metastasis.Results:Of the 146 included patients, synchronous or metachronous distance metastasis was confirmed in 43 (29.4%) cases. The patients’ baseline data and univariate analysis showed that mrEMVI, maximum tumor diameter, mr T Stage, pathological N stage, number of lymph node metastasis, cancer nodules, preoperative serum CEA, (Carcinoembryonic antigen) and CA199 were associated with distant metastasis. In the multiple logistic regression model, mrEMVI, pathological N stage, number of lymph node metastasis, maximum tumor diameter, and preoperative serum CEA were identified as independent risk factors for distant metastasis: mrEMVI [odds ratio (OR) = 3.06], pathological N stage (OR = 6.52 for N1 vs N0; OR = 63.47 for N2 vs N0), preoperative serum CEA (OR = 0.27), tumor maximum diameter (OR = 1.03), number of lymph nodes metastasis (OR = 0.62). And, the receiver operating characteristic (ROC) curve was plotted and the area under the curve was calculated (area under the curve [AUC) = 0.817, 95% CI = 0.744-0.890, P < .001].Conclusions:mrEMVI, pathological N stage, number of lymph node metastasis, maximum tumor diameter and preoperative serum CEA are the independent risk factors for distant metastasis in T3 T4 rectal cancer. A comprehensive analysis of the risk factors for distant metastasis in rectal cancer can provide a reliable basis for formulating individualized treatment strategies, follow-up plans, and evaluating prognosis.

中文翻译：

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T3 T4 直肠癌远处转移的危险因素

背景：远处转移是直肠癌患者死亡的主要原因。本研究旨在通过磁共振成像（MRI）、病理特征及血清指标等综合分析T3 T4直肠癌远处转移的危险因素。方法：收集1月份以来146例T3 T4直肠癌根治术后的临床病理资料。对2015年至2023年3月进行回顾性分析。收集所有病例术前、术后随访数据，筛查远处转移病灶。采用单因素和多因素Logistic回归方法分析MRI特征、病理结果、血清检测指标与远处转移之间的关系。结果：纳入的146例患者中，43例（29.4%）确诊为同步或异时远处转移。患者基线数据及单因素分析显示，mrEMVI、肿瘤最大直径、mr T分期、病理N分期、淋巴结转移数量、癌结节、术前血清CEA（癌胚抗原）、CA199与远处转移相关。在多元Logistic回归模型中，mrEMVI、病理N分期、淋巴结转移数量、肿瘤最大直径和术前血清CEA被确定为远处转移的独立危险因素：mrEMVI[优势比（OR）= 3.06]、病理N分期（N1 vs N0 OR = 6.52；N2 vs N0 OR = 63.47）、术前血清 CEA（OR = 0.27）、肿瘤最大直径（OR = 1.03）、淋巴结转移数量（OR = 0.62）。并且，绘制受试者工作特征（ROC）曲线并计算曲线下面积（曲线下面积[AUC] = 0.817，95% CI = 0.744-0.890，P < .001]。结论：mrEMVI，病理学N分期、淋巴结转移数量、肿瘤最大直径和术前血清CEA是T3 T4直肠癌远处转移的独立危险因素。全面分析直肠癌远处转移的危险因素，可为制定个体化治疗策略、随访计划、评估预后提供可靠依据。