摘要
目的 探讨同时性、异时性结直肠癌肝转移的临床特点及不同治疗策略对患者预后的影响.方法 回顾性分析中山大学附属第一医院1994-2006年结直肠癌数据库中肝转移患者的临床及随访资料.采用Kaplan-Meier法绘制生存曲线,Log-Rank法比较生存率,Cox比例风险回归模型进行多因素分析.结果 共有486例患者发生肝转移,其中同时性肝转移191例,异时性肝转移295例,两组5年生存率差异具有统计学意义（9.3%vs.21.5%,P＜0.01）;全组患者中267例行手术切除,151例行射频消融治疗,68例保守治疗,三种治疗方法的5年生存率分别为22.1%,10.3%和0,三组之间差异有统计学意义（P＜0.01）.单因素分析显示,年龄、肝转移类型、术前CEA、原发瘤N分期、分化程度、肠梗阻、腹水、肿瘤直径、治疗策略等因素与患者预后密切相关;多因素分析显示,肝转移类型、术前CEA、腹水、治疗策略是影响预后的独立危险因素. 结论肝转移的不同类型是决定结直肠癌肝转移患者预后的重要因素;根治性手术切除与射频消融、保守治疗相比更能改善结直肠癌肝转移患者预后.
Objective To investigate the clinical characteristics and prognosis of patients with synchronous or metachronous liver metastasis of colorectal cancer. Methods Clinical data of patients with colorectal cancer liver metastasis from 1994 to 2006 in the First Affiliated Hospital of Sun Yat-Sen University was retrospectively analyzed. The Kaplan-Meier method and long-rank test were used for bivariate comparisons. Multivariate analysis was done by the Cox regression model （Backward Wald）. Results A total of 486 patients with colorectal cancer liver metastasis, including 191 synchronous and 295 metachronous liver metastasis, were analyzed. The overall 5-year cumulative survival rate was 16.2%, 9. 3% forsynchronous and 21.5% for metachronous liver metastasis respectively （ P 〈 0. 01 ）. Liver metastasis was surgically resected in 267 patients, 151 received radiofrequency ablation and 68 underwent conservative therapy with 5-year cumulative survival rates of 22. 1%, 10. 3% and 0 （ P 〈 0. 01 ） respectively. On univariate analysis, poor prognosis was associated with older age, synchronous metastasis, higher serum CEA level, advanced N stage and poor differentiation of the primary tumor, bowel obstruction, ascites, tumor longitudinal length over 8cm, non-surgery therapy. Multivariate analysis indicated that synchronous metastasis, serum CEA level, ascites and therapy method were independent prognosis factors. Conclusions The time at which a metastasis occur, serum CEA level,ascites and curative surgical therapy determine the prognosis of patients with colorectal cancer liver metastasis. Surgical resection of metastasis in selected patients could prolong survival.
出处
《中华普通外科杂志》
CSCD
北大核心
2010年第8期635-638,共4页
Chinese Journal of General Surgery
关键词
结直肠肿瘤
肿瘤转移
肝
预后
Colorectal neoplasms
Neoplasm metastasis
Liver
Prognosis
