122例结直肠癌同时性肝转移患者的临床预后分析  

Prognostic Analysis of 122 Colorectal Cancer Cases with Synchronous Liver Metastases

作　　者：罗吉辉[1] 高枫[1] 张森[1] 陈利生[1] 杨剑锋[1] 

机构地区：[1]广西医科大学第一附属医院结直肠肛门外科,南宁市530021

出　　处：《中国肿瘤临床》2009年第6期308-312,共5页Chinese Journal of Clinical Oncology

基　　金：国家自然科学基金(编号:60560150;30672059);广西医疗卫生重点课题(编号:桂卫重 200404)

摘　　要：目的:探讨影响结直肠癌同时性肝转移患者预后的因素和治疗选择。方法:回顾性分析广西医科大学2000年1月至2005年12月收治的结直肠癌同时性肝转移患者122例,用Kaplan-Meier分析本组患者的总生存率,用Log-rank检验和COX模型(SPSS13.0)对影响生存的18项临床病理因素和临床治疗方法进行单因素和多因素分析。结果:该组患者1年,2年,3年,5年生存率分别为52.46%,24.59%,12.30%,3.28%,单因素分析结果显示原发肿瘤的大小、分化程度、淋巴结转移、癌性梗阻、肝转移灶部位、肝转移灶数目、肝转移灶大小,肝外侵犯或转移、确诊时CEA水平,手术性质,原发瘤切除,化疗方式及化疗方案为预后影响因素。多因素分析显示,肿瘤分化程度,癌性梗阻,CEA水平及手术性质为独立的预后因素。结论:对于结直肠癌同时性肝转移患者,原发瘤的分化程度低,伴癌性梗阻及术前CEA高提示患者预后不良。治疗方式对结直肠癌肝转移患者有重要影响,对于仅存在肝转移的结直肠癌患者应尽积极手术根治原发灶及肝转移灶,介入化疗优于外周静脉全身化疗,全身化疗最好选用含草酸铂的化疗方案。Objective： To explore the prognostic factors and treatment choices for colorectal cancer patients with liver metastases. Methods： Data from a total of 122 colorectal cancer patients with liver metastases treated at Guangxi Medical University from January 2000 to December 2005 were collected and reviewed. The total survival rate was analyzed by Kaplan-Meier method. Log-rank method and Cox regression model with SPSS13.0 software were used to analyze 18 factors including clinical pathological factors and treatment choices. Results： The median survival time of 122 patients with simultaneous liver metastases from colorectal cancer was 13 months. The 1-, 2-, 3- and 5-year survival rates were 52.46%, 24.59%, 12.30%, and 3.28%, respectively. Univariate analysis with Kaplan-Meier methods revealed that the size of the primary tumor, differentiation, N status, cancerous ileus, extrahepatic disease, serum CEA level at diagnosis, treatment modality, primary site resection, chemotherapy regimen, and chemotherapy modality as well as the number, size and distribution of liver metastases were prognostic factors. Multivariate analysis showed that cancerous ileus, differentiation, serum CEA value at diagnosis and treatment modality were independent prognostic factors for colorectal cancer patients with synchronous liver metastases. Cenclusion： Liver metastases with poor differentiation, cancerous ileus, and high CEA level are adverse prognostic factors. Primary tumor resection and liver resection should be considered for all suitable patients with colorectal metastases in the liver. Intervention chemotherapy is better than that chemotherapy through outer veins. Systemic chemotherapy containing oxaliplatin remains the best choice for chemotherapeutic treatment.

关 键 词：结直肠癌/原发性 同时性肝转移预后 单因素分析 多因素分析 

分 类 号：R735.3[医药卫生—肿瘤]