结直肠癌肝转移生存分析  

Liver metastases of colorectal cancer: a survival analysis

作　　者：朱德祥[1,2] 任黎[1,2] 韦烨[1,2] 钟芸诗[1,2] 刘天舒[1,3] 叶清海[1,4] 梁立[1,2] 潘向欧[1,2] 翟升永[1,2] 徐博[1,2] 许剑民[1,2] 樊嘉[1,4] 秦新裕[1,2] 

机构地区：[1]复旦大学附属中山医院 [2]复旦大学普通外科研究所普外科,上海200032 [3]复旦大学普通外科研究所肿瘤科,上海200032 [4]复旦大学普通外科研究所肝外科,上海200032

出　　处：《中国实用外科杂志》2011年第11期1022-1026,共5页Chinese Journal of Practical Surgery

基　　金：卫生部部属(管)医院临床学科重点项目(2010-2012年度项目);2009年上海市科委生物医药处面上项目(09411967100);2008年上海市科委重点课题(08431910200);2009年国家自然科学基金项目(30973416)

摘　　要：目的分析结直肠癌肝转移病人的生存状况和相关影响因素。方法回顾性分析2000—2010年复旦大学附属中山医院收治的结直肠癌肝转移病人的临床资料、病理、治疗策略等情况，进行生存状况分析，并采用单因素和Cox比例风险回归模型等分析影响结直肠癌肝转移生存的相关因素。结果结直肠癌肝转移病人总体中位生存期22．0个月，5年存活率为16％，其中同时性肝转移为21．2个月和16％，异时性肝转移为30．1个月和23％，同时性肝转移组的存活率明显低于异时性肝转移组（P〈0．01）。按治疗方式分组，手术组病人的中位生存期为49．8个月，5年存活率为37％，显著优于化疗组（22．2个月和0）、介入组（19．0个月和11％）、化疗＋介入组（22．8个月和10％）、局部治疗组（28．5个月和0）。同时性肝转移、肠癌原发灶分化Ⅲ-Ⅳ级、肝转移灶≥4个、最大肝转移灶≥5cm和肝转移灶非手术处理是影响病人预后的独立危险因素。结论同时性肝转移病人生存期低于异时性肝转移。积极手术治疗可以改善病人存活率。扩大肝转移灶切除的适应证对病人存活率无显著影响。独立危险因素的评分体系可以评估病人的预后。Objective To investigate survival in patients with liver metastases of colorectal cancer and identify risk factors associated with survival. Methods Clinical, pathologic, treatment and complete follow-up data of the consecutive cases of colorectal liver metastasis admitted between 2000 and 2010 in Zhongshan Hospital of Fudan University were analyzed retrospectively. The prognostic value of different factors was studied through univariate and multivariate analyses. Results The median survival was 22.0 months and 5-year survival rate was 16%. Survival of synchronous liver metastases （21.2 months and 16%） was lower than that of metachronous liver metastases （30.1 months and 23%, P〈0.01）. Survival after resection of liver metastases was 49.8 months and 37%, which was higher than that after chemotherapy （22.2 months and 0）, that after intervention （19.0 months and 11% ）, that after chemotherapy combined with intervention （22.8 months and 10% ） and that after local regional treatment （28.5 months and 0）. Five factors were found to be significant and independent predictors of poor survival by multivariate analysis： simuhaneous liver metastases （P=0.005）, poorly differentiated primary （P=0.005）, number of liver metastases ≥ 4 （P=0.008）, largest liver metastases ≥5 cm （P=0.007）, and no surgical treatment of liver metastases （P〈0.001）. Conclusion Survival of synchronous liver metastases is lower than that of metachronous liver metastases. Resection of liver metastases provides good long-term survival benifit for patients with resectable and initially irreseetable liver metastases. Expansion of the indications for liver resection is acceptable. Long-term survival outcome can be predicted from a risk factor scoring system.

关 键 词：结直肠癌肝转移 生存分析 

分 类 号：R6[医药卫生—外科学]