摘要
目的探究结直肠癌同时性肝转移患者的临床病理特点,并分析影响其预后的相关因素,以期指导外科治疗决策。方法回顾性分析中山大学附属第一医院自1994年8月至2009年12月收治的结直肠癌同时性肝转移患者231例,分析其预后与临床病理因素的关系。结果确诊时合并肝转移患者占同期结直肠癌患者总数的8.46%(231/2732)。该组患者1、3、5年生存率分别为70.2%、21.9%,和11.4%,中位生存时间19个月。单因素分析显示:肿瘤周径(P=0.017)、浆膜侵犯(P=0.000)、肝转移分期(P=0.000)、浸润深度(P=0.010)、肿瘤分化程度(P=0.007)、手术方式(P=0.000)和化疗(P=0.041)影响患者预后。肝转移H1组患者1、3和5年生存率分别为88.4%、39.7%和21.3%,肝转移H2组分别为64.1%、15.7%和7.8%,肝转移H3组分别为55.0%、9.2%和0.0%(P<0.01)。根治性手术组患者1、3和5年生存率分别为84.6%、37.9%和19.8%,姑息手术组分别为60.2%、24.0%和0.05%,减状手术或者未手术组1、3、5年生存率分别为37.0%、0.09%和0.0%(P<0.01)。Cox回归模型多因素分析显示,只有肝转移分期(P=0.000)和手术方式(P=0.010)是结直肠癌肝转移患者的独立预后因素。结论结直肠癌肝转移分期影响预后,应早期发现和诊治。对于结直肠癌仅有肝转移的患者应尽可能手术切除原发灶和肝转移病灶,化疗可以改善姑息术后患者的预后。
Objective To investigate the clinicopathological characteristics of colorectal cancer with synchronous liver metastasis,and analyze its prognostic factors.Methods Clinical data of 231 colorectal cancer patients with synchronous liver metastasis who were admitted in the First Affiliated Hospital of Sun Yat-sen University from August 1994 to December 2009 were analyzed retrospectively.The relationship between clinicopathological parameters and prognosis was investigated.Results The patients with synchronous liver metastasis accounted for 8.46% of total 2732 colorectal cancer patients.The overall 1,3 and 5-year survival rates of 231 patients with synchronous liver metastasis were 70.2%,21.9% and 11.4% respectively.The median survival time was 19 months.Univariate analysis revealed that tumor circumference,serosal invasion,stage of liver metastasis,invasion depth,tumor differentiation,surgical method and chemotherapy affected the patients' prognosis.The overall 1,3,5-year survival rates of the patients with H1 metastasis were 88.4%,39.7% and 21.3%,with H2 stage 64.1%,15.7% and 7.8%,with H3 stage 55.0%,9.2% and 0.0%,respectively(P<0.01).The 1,3,5-year survival rates of the patients with radical resection were 84.6%,37.9% and 19.8%,with palliative resection 60.2%,24.0% and 0.05%,with non-resection procedures 37.0%,0.09% and 0.0%(P<0.01).Multivariate analysis revealed that only stage of liver metastasis and surgical method were independent prognostic factors for colorectal cancer patients with synchronous liver metastasis.Conclusions Stage of liver metastas is and radical resection are most important prognostic factors for colorectal cancer patients with synchronous liver metastasis,thus early detection and radical surgery for primary tumor together with liver lesion are necessary for the patients without extra-hepatic metastasis.Chemotherapy can improve survival time of the patients after palliative surgery.
出处
《消化肿瘤杂志（电子版）》
2011年第2期100-104,共5页
Journal of Digestive Oncology(Electronic Version)
关键词
结直肠癌
肝转移
手术
预后
Colorectal neoplasms
Liver metastasis
Surgery
Prognosis
