中国实用外科杂志

中国实用外科杂志

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结直肠癌肝转移综合治疗预后因素分析（附317例报告）

闫晓峦，王    崑，包    全，孙    谊，王宏伟，金克敏，邢宝才   

  1. 北京大学肿瘤医院暨北京市肿瘤防治研究所肝胆外一科  恶性肿瘤发病机制及转化研究教育部重点实验室，北京 100142
  • 出版日期:2016-04-01 发布日期:2016-03-29

  • Online:2016-04-01 Published:2016-03-29

摘要：

目的    探讨影响结直肠癌肝转移以外科手术为主的综合治疗疗效的预后风险因素。方法    回顾性分析北京大学肿瘤医院肝胆胰外一科2005年1月至2015年1月行肝切除手术治疗317例结直肠癌肝转移病人的临床资料及术后随访情况。结果    全组病人1、3、5年总存活率分别为90.5%、54.5%、45.0%。中位生存期43个月。单因素分析结果显示性别、原发灶淋巴结转移、肝转移灶最大径、肝转移灶出现时间、癌胚抗原（CEA）水平及是否存在肝外转移灶是影响预后的因素（P<0.05）；多因素分析结果显示原发灶淋巴结转移、同时性肝转移和CEA>30 μg/L是影响预后的独立危险因素。结论    以外科手术为主的综合治疗可显著改善结直肠癌肝转移病人的长期生存，多种临床风险因素影响病人预后。

关键词: 结直肠癌, 肝转移, 肝切除, 综合治疗, 预后分析

Abstract:

Long-term survival after hepatectomy for metastatic colorectal cancer: A retrospective analysis of 317 consecutive cases at a single-institution        YAN Xiao-luan, WANG Kun, BAO Quan, et al. Hepatobiliary and Pancreatic Surgery Unit I, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
Corresponding author: XING Bao-cai，E-mail: xingbaocai88@ sina.com
Abstract    Objective    To identify risk factors associated with overall survival(OS) for patients performed hepatic resection for metastatic colorectal cancer. Methods    The clinical, pathologic, and complete follow-up data were prospectively collected from 317 consecutive patients performed primary hepatic resection for colorectal liver metastases at Beijing Cancer Hospital from January 2005 to January 2015. Parametric survival analysis was used to identify predictors of cancer-specific survival. Results    The 1-, 3- and 5-year overall survival were 90.5%, 54.5% and 45.0%, respectively. The median survival time was 43 months. Univariate analysis found 6 risk factors including gender, lymph node dissemination of the primary tumor, diameter of metastases>3 cm, synchronous metastases, carcinoembyonic antigen level >30 μg/L, and extra-hepatic disease（P<0.05）. On multivariate analysis, 3 risk factors were found to be independent predictors of poor survival, which included lymph node dissemination of the primary tumor, synchronous metastases, CEA>30 μg/L. Conclusion    Resection of liver metastases provides long-term cancer-specific survival benefit. Clinicopathological characteristics including lymph node dissemination of the primary tumor, synchronous metastases, CEA>30 μg/L were predictors of adverse outcome.

Key words: colorectal cancer, liver metastases, hepatectomy, comprehensive treatment, prognosis analysis