结直肠癌肝转移根治性切除预后因素分析  

Prognosis of radical resection of liver metastases from colorectal cancer

作　　者：李清国 赵广法[2] 王道荣 陈平 陈静贵[2] 陈杰 

机构地区：[1]扬州市苏北人民医院外科,江苏省225001 [2]复旦大学附属肿瘤医院肿瘤外科

出　　处：《中华普通外科杂志》2013年第9期665-668,共4页Chinese Journal of General Surgery

摘　　要：目的 分析影响结直肠癌肝转移患者根治性手术切除预后的临床病理因素,探讨改善患者预后的方法.方法 收集2005年1月至201 1年12月江苏省苏北人民医院和复旦大学附属肿瘤医院收治的103例结直肠癌肝转移根治性切除患者的临床资料.采用Kaplan-Meier法计算生存率,用Log-rank法分析患者生存情况,对各种影响预后的因素分别进行单变量和多变量Cox回归分析.结果 103例患者均获随访,随访时间10～ 60个月,术后1、3、5年生存率分别为90％、49％、39％.单因素分析结果显示：肝转移灶数目、大小、分布、术前CEA水平、手术并发症、术后化疗是肝转移灶切除术后的影响因素（x2值分别为24.732、9.461、9.568、25.948、25.370、5.701,P＜0.05）；多因素分析显示,肝转移灶数目、肝转移灶切除术前CEA水平、手术并发症是影响预后的独立因素（Wald=7.974、12.051、11.547,P＜0.05）.结论 肝转移灶数目、肝转移灶切除术前CEA水平和手术并发症是影响结直肠癌肝转移患者预后的独立因素.适当扩大手术切除的适应证,加强对高危患者的随访和术后辅助化疗,可能改善肝转移患者的预后.Objective To analyze the clinicopathologieal factors impacting on the prognosis of coloreetal cancer liver metastases and to investigate how to improve patients＇ survival. Methods The clinical data of 103 patients who received radical resection for liver metastases from colorectal cancer from January 2005 to December 2011 were enrolled. The survival curve was drawn by Kaplan-Meier method, and the survival rates were analyzed by Log-rank test. Factors influencing survival were analyzed by Cox regression model. Results All patients were followed up from 10 to 60 months, The 1-, 3-, 5-year＇s survival rates were 90% , 49% , 39% , respectively. Univariate analysis revealed that number and size of liver metastases, distribution of liver metastases, serum CEA concentration, complications, postoperative chemotherapy were related to prognosis（x2 =24. 732, 9. 461,9. 568, 25. 948, 25. 370, 5. 701 ,P 〈0. 05）. Multivariate analysis identified number of liver metastases, serum CEA concentration, complications were as significant predictors of survival （ Wald = 7. 974, 12. 051, 11. 547, P 〈 0. 05 ）. Conclusions Number of liver metastases, serum CEA concentration, complication are important prognostic factors for liver metastases from colorectal cancer. Appropriate expansion of surgical indication, early diagnosis with intensive follow-up is crucial to increase the survival rate after hepatectomy for liver metastasis of coloractal carcinoma.

关 键 词：结直肠肿瘤 肝肿瘤 肝切除术 预后 

分 类 号：R735.3[医药卫生—肿瘤]