摘要
目的分析结直肠癌肝转移(CRLM)手术治疗患者预后及相关影响因素。方法回顾性分析2001年1月至2020年12月在北京大学肿瘤医院行结直肠癌肝转移手术的1 139例患者资料。依据手术时间分为A组(2001年1月至2012年12月, 183例)、B组(2013年1月至2020年12月, 956例)。对比两组间生存差异及相关影响因素。结果 A组和B组中位总生存(OS)时间分别为34.3个月(95%CI为27.7个月~41.0个月)和54.7个月(95%CI为48.5个月~60.9个月), 5年OS率分别为31.9%和47.2%;中位无瘤生存(DFS)时间分别为10.1个月(95%CI为8.2~12.1个月)和12.2个月(95%CI为11.1~13.2个月), 5年DFS率分别为16.9%和26.4%。多因素分析提示女性、累积疾病评分2~3分、T3-T4期、N1-N2期、RAS/BRAF基因突变、围手术期未行靶向治疗、肝转移病灶多发、术前病灶最大直径>30 mm、术前癌胚抗原>20 ng/mL、大范围肝切除是较差OS的独立危险因素(均P<0.05)。结论 CRLM是生物学行为较好的一类疾病, 应采取积极治疗态度, 多学科会诊的广泛应用以及多手段联合的治疗策略正逐渐改善CRLM患者预后。未来需要更多手段去判断患者肿瘤生物学行为, 期望进一步改善患者预后。
Objective To analyze the prognosis and related factors of patients with colorectal liver metastasis(CRLM)after surgery.Methods The data of 1139 patients with colorectal cancer in Peking University Cancer Hospital from January 2001 to December 2020 were retrospectively analyzed.The patients were divided into Group A(183 patients from January 2001 to December 2012)and Group B(956 patients from January 2013 to December 2020)based on the surgical time,and the survival difference and related influencing factors between the two groups were compared.Results The median overall survivals(OS)of group A and B were 34.3 months(95%CI:27.7-41.0 months)and 54.7 months(95%CI:48.5-60.9 months),with 5-year OS rates of 31.9%and 47.2%,respectively.The median disease-free survivals(DFS)of group A and B were 10.1 months(95%CI:8.2-12.1 months)and 12.2 months(95%CI:11.1-13.2 months),with 5-year DFS rates of 16.9%and 26.4%,respectively.Multivariate analysis indicated that female,cumulative disease score 2-3,T3-T4 phase,N1-N2 phase,RAS/BRAF gene mutation,no perioperative period targeted therapy,multiple liver metastasis,maximum preoperative lesion diameter>30 mm,preoperative carcinoembryonic antigen>20 ng/mL,and extensive liver resection were independent risk factors for poor OS(all P<0.05).Conclusions CRLM is a type of disease with good biological behavior and should be treated actively.The extensive application of muti-disciplinary treatment and the strategy of combining multiple therapies are gradually improving the prognosis of CRLM patients.In the future,more methods are necessary to assess the tumor biological behavior of patients,and increase opportunities of local treatment to further improve the prognosis of patients with CRLM.
作者
王明帅
王宏伟
包全
金克敏
王崑
邢宝才
Wang Mingshuai;Wang Hongwei;Bao Quan;Jin Kemin;Wang Kun;Xing Baocai(Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing),Hepatopancreatobiliary Surgery Department I,Peking University Cancer Hospital&Institute,Beijing 100142,China)
出处
《中华转移性肿瘤杂志》
2024年第1期10-17,共8页
Chinese Journal of Metastatic Cancer
基金
北京市自然科学基金(7192035)
北京市医院管理局临床医学发展专项资金支持(ZYLX202116)
北京市医院管理局“使命”计划(SML20191101)
北京首都健康改善与研究基金(CFH2022-1-2151)。
关键词
结直肠癌肝转移
肝切除
综合治疗
预后
Colorectal liver metastases
Hepatectomy
Survival curve
Combined treatment
Prognosis
