结直肠癌肝转移患者临床预后的多因素分析  

Multiple factor analysis on the prognosis of colorectal cancer patients with liver metastases

作　　者：陆霓虹 王文玲[1] 文小平[1] 

机构地区：[1]贵州省肿瘤医院腹部肿瘤科,贵阳550004

出　　处：《肿瘤》2009年第12期1140-1145,共6页Tumor

基　　金：贵州省科技厅基金资助项目(编号:E2008-20)

摘　　要：目的:探讨影响结直肠癌肝转移患者预后的相关临床病理因素及其治疗方法的选择。方法:回顾性分析贵州省肿瘤医院1997年3月—2007年3月收治的146例结直肠癌肝转移患者,对其相关的临床病理资料进行统计学分析,应用寿命表法计算生存率,绘制Kaplan-Meier生存曲线并应用log-rank检验对患者的临床病理特征及治疗方法进行单因素分析,应用COX回归模型进行多因素分析并计算预后指数(prognostic index,PI),根据PI值将患者分为不同的危险组,并比较各组的生存率。结果:全组总的1、3和5年生存率分别为62.0%、15.5%和6.2%。单因素分析显示,病理类型、肿瘤细胞分化程度、确诊时血清癌胚抗原(carcinoembryonic antigen,CEA)水平、是否有区域淋巴结转移、肝转移瘤大小及数目、肝转移灶分布、肝转移瘤诊断时间、是否合并肝外侵犯、肝转移灶是否手术、是否行化疗及化疗方案的选择等与结直肠癌肝转移患者的预后相关。多因素分析显示,确诊时血清CEA水平、有无肝外转移、肝转移瘤大小及数目、原发病灶切除和化疗方案为独立的预后影响因素。高危组、中危组和低危组患者生存率的两两比较,差异有统计学意义(P<0.05)。结论:治疗方法的选择对结直肠癌肝转移患者的预后具有重要影响,积极治疗原发病灶及转移灶可提高患者的生存率。血清CEA水平、有无肝外转移、肝转移瘤大小和数目等因素与预后明显相关。PI值可用于结直肠癌肝转移患者的预后评估。Objective：To investigate the clinicopathological factors affecting the prognosis of colorectal cancer patients with liver metastasis and how to select therapeutic method.Methods：The clinical records of 146 colorectal cancer patients with liver metastases who were admitted in Cancer Hospital of Guizhou Province from March 1997 to March 2007 were collected and made a retrospective analysis.The survival rate of the 146 patients was calculated by using life table method.Kaplan-Meier method and log-rank test were used for univariate analysis on clinicopathological features and therapeutic modalities.The multivariate analysis was performed by using COX regression model.The prognostic index（PI） of patients was calculated based on the result of multivariate analysis.The patients were classified into different risk groups according to PI value and the survival rate was compared between the different groups.Rusults：The overall 1-,3-,and 5-year survival rates were 62.0%,15.5%and 6.2%,respectively.Univariate analysis revealed that the following factors were related with the prognosis of colorectal cancer patients with liver metastasis.They included pathological classification,histological grade,serum CEA（carcinoembryonic antigen）level,primary tumor resection,local lymph node metastasis,number and size of liver metastases,distribution and initiation time of liver metastases,extrahepatic invasion,with or without surgery and che-motherapy for liver metastasis,and chemotherapeutic regimen selection.Multivariate analysis showed that the serum CEA level,extrahepatic metastasis,number and size of liver metastases,primary tumor resection,and chemotherapeutic regimen were independent prognostic factors for colorectal patients with liver metastasis.Conclusion：The therapeutic modality had an obvious effect on the prognosis of colorectal cancer with liver metastasis.Active treatment for primary tumor and metastatic lesions increased the survival rate of patients.Serum CEA levels,with or without extrahepatic metastases,an

关 键 词：结直肠肿瘤 肿瘤转移 预后 

分 类 号：R735.3[医药卫生—肿瘤]