根治性切除治疗结直肠癌肝转移的效果及术后肝转移瘤复发危险因素分析  

Effectiveness of curative resection for colorectal cancer with liver metastasis and analysis of risk factors of intrahepatic recurrence after surgical therapy

作　　者：郑梓煜[1] 陈剑辉[2] 蔡锐彬[1] 黄安培[2] 黄应雄[1] 崔冀[2] 

机构地区：[1]中山大学附属第一医院急诊科,广州510080 [2]中山大学附属第一医院胃肠外科,广州510080

出　　处：《第三军医大学学报》2016年第6期623-628,共6页Journal of Third Military Medical University

基　　金：广东省科技计划基金(2013B021800114)~~

摘　　要：目的观察结直肠癌肝转移（colorectal cancer with liver metastasis,CRCLM）患者行根治性切除的疗效,分析影响术后肝转移瘤复发的危险因素。方法回顾性分析我院1993-2013年收治的行根治性切除术的结直肠癌肝转移患者164例资料,绘制其术后远期生存率及无瘤生存率曲线。对影响术后肝转移瘤复发的因素分别进行单因素分析和多因素分析。结果术后第1、2、3、5年生存率分别为90.9%、72.1%、57.1%和26.0%,中位生存期为32（1~162）个月;术后第1、2、3、5年无瘤生存率分别为49.4%、38.4%、25.0%和14.0%,中位无瘤生存时间为12个月。术后并发症发生率为16.5%,术后30 d死亡率为1.2%。术后肝转移瘤复发率为46.3%,其中,边缘复发5例（6.6%）,同一肝段复发7例（9.2%）,邻近肝段复发7例（9.2%）,远隔肝段复发13例（17.1%）,多发肝段复发44例（57.9%）。各复发类型相比差异无统计学意义（P=0.062）。单因素分析显示原发瘤分化程度（P=0.035）、癌胚抗原（carcino-embryonic antigen,CEA）（P=0.013）、原发瘤区域淋巴结转移（P=0.043）和肝转移瘤切缘（P=0.012）与术后肝转移瘤复发相关;多因素分析显示原发瘤分化程度（P=0.021）和CEA（P=0.015）为影响术后肝转移瘤复发的独立危险因素。结论结直肠癌肝转移根治性切除术后远期生存率高,原发瘤分化程度和术前血浆CEA水平为影响术后肝转移瘤复发的独立危险因素。Objective To summarize the survival outcomes of colorectal cancer with liver metastasis （CRCLM） after curative resection, and analyze the risk factors associated with intrahepatic recurrence. Methods From January 1993 to December 2013, a total of 164 patients with liver metastasis from eolorectal cancer, who accepted radical resection, were enrolled into the study. Survival curve and disease-free survival curve were constructed. Univariate analysis and multivariate analysis were performed to study the risk factors associated with intrahepatic recurrence after surgery. ~esults The median disease-free survival （DFS） rate and overall survival （OS） rate after surgery were 12 months and 32 months （1 - 162 months）, respectively. The 1-year, 2-year, 3-year and 5-year DFS rates were 49.4% and the corresponding OS rates were 90.9%, 72. 1%, 57. 38.4%, 25.0% and 14.0%, respectively, 1% and 26.0%, respectively. Postoperativemortality was 16.5%, and 30-day morbidity was 1.2%. Intrahepatic recurrence was found in 46.3% of patients postoperatively. The frequencies of intrahepatic recurrence were as follows： marginal 6.6%, same segment 9.2%, adjacent segment 9.2%, distal segment 17.1%, and multiple segment 57.9%. There were no significant differences in the sites of intrahepatic recurrence. Based on univariate analysis, the primary tumor cell differentiation （ P = 0. 035 ）, carcinoembryonic antigen （ CEA ） （ P = 0. 013 ）, N-status （ P = 0. 043） and resection margin width （ P = 0. 012） were risk factors of postoperative intrahepatic recurrence. Based on multivariate analysis, the primary tumor cell differentiation （ P = 0. 021 ） and CEA （ P = 0. 015 ） were independent risk factors of postoperative intrahepatic recurrence. Conclusion Radical resection for CLCLM results in long-term survival, and it offers potentially curative treatment for hepatic metastasis from colorectal cancer. Primary tumor cell differentiation and preoperative plasma CEA level are independent risk factors for pre

关 键 词：结直肠癌 肝转移 肝肿瘤 危险因素 

分 类 号：R730.56[医药卫生—肿瘤] R735.35[医药卫生—临床医学]