异时性结直肠癌肝转移新辅助化疗对手术疗效的临床价值  

Neoadjuvant chemotherapy in candidates for surgical resection with metachronous colorectal carcinoma

作　　者：施长鹰[1] 杨甲梅[1] 郑涛[1] 戴炳华[1] 谢峰[1] 

机构地区：[1]第二军医大学第三附属医院(东方肝胆外科医院)特需治疗一科,上海200438

出　　处：《腹部外科》2015年第4期250-253,261,共5页Journal of Abdominal Surgery

基　　金：天晴肝病研究基金（CFHP20132193）

摘　　要：目的：探讨异时性结直肠癌肝转移（colorectal cancer liver metastasis,CLM）病人术前新辅助化疗对预后的影响,分析手术切除治疗的预后影响因素。方法回顾2007年3月至2010年2月82例手术切除治疗 CLM 病人的临床资料和随访信息,进行生存分析并比较新辅助化疗与否对手术、预后的影响。结果全组病人均根治性切除,1、3、5年总生存率100%、80%、13%,FOLFOX 新辅助化疗27例,直接手术55例,两组比较总生存期差异无统计学意义（P =0.192）,直接手术组术前丙氨酸转氨酶、天冬氨酸转氨酶水平较新辅助化疗组低,直接手术组手术时间更短、术中输血率、术后并发症均低于新辅助化疗组。预后不良因素包括肿瘤低分化、6次以上新辅助化疗、癌胚抗原〉200μg/L、危险度评分〉2分、原发瘤术后1年以内的肝转移。结论可切除异时性 CLM 病人可能无法从术前新辅助化疗中生存获益,并有增加手术并发症的风险,行新辅助化疗应慎重。肿瘤分化程度是影响预后的独立因素。Objective To explore the efficacy of neoadjuvant chemotherapy for patients with meta-chronous colorectal carcinoma liver metastases （CLM）and explore its potential influencing factors.Methods A total of 82 CLM patients were recruited.And their clinical and follow-up data were analyzed retrospec-tively.Survival analysis and comparison were conducted between neoadjuvant chemotherapy and surgery alone groups.Results All candidates underwent radical resection and 1,3 and 5-year survival rates were 100%,80% and 13% respectively.And 27 patients received neoadjuvant chemotherapy with FOLFOX regimen while the remainder was operated directly.No difference on survival was detected.The surgery alone group fared better than neoadjuvant chemotherapy group in preoperative alaninine aminotransferase （ALT）＆ aspartate aminotransferase （AST）,operative duration,transfusion rate and postoperative complications. Poor prognostic factors included poor differentiation tumor,〉6 cycles of neoadjuvant chemotherapy,carci-noembryonic antigen （CEA）〉200 μg/L,CRS〉2 and liver metastasis within 1 year.Conclusions Resect-able metachronous CLM may not benefit from neoadjuvant chemotherapy but may increase postoperative complications.Neoadjuvant chemotherapy is not recommended.And tumor differentiation is an independent influencing factor for survival.

关 键 词：结直肠癌肝转移 手术切除 新辅助化疗 生存期 

分 类 号：R574.2[医药卫生—消化系统]