转化治疗在结直肠癌肝转移患者治疗中的价值  

Value of conversion therapy in treatment of patients with colorectal cancer liver metastasis

作　　者：马蕊[1] 李涛[2] Ma Rui;Li Tao(Department of Critical Care Medicine,Peking University People's Hospital,Beijing 100044,China;Department of Hepatobiliary Surgery,Peking University People's Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院重症医学科,100044 [2]北京大学人民医院肝胆外科,100044

出　　处：《中华肝脏外科手术学电子杂志》2021年第4期398-402,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：北京市自然科学基金(7192212)。

摘　　要：目的探讨转化治疗在结直肠癌肝转移(CRLM)患者治疗中的价值及转化成功相关影响因素。方法回顾性分析2011年1月至2019年6月北京大学人民医院收治的78例CRLM患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男51例,女27例;年龄39-77岁,中位年龄58岁。根据肝转移灶评估结果,对初始可切除患者采用原发灶和肝转移灶一期切除,术后化疗。对初始不可切除患者采用贝伐珠单抗联合XELOX方案或西妥昔单抗联合FOLFIRI方案转化治疗,转化治疗成功患者采用以手术为主的综合治疗。生存分析采用Kaplan-Meier法和Log-rank检验。转化治疗成功相关因素分析采用χ^(2)检验。结果初始可切除患者40例,初始不可切除患者38例。CRLM转化治疗成功率32%(12/38),其中肝切除5例,肝切除联合射频消融6例,门静脉结扎二期切除1例。初始手术切除患者和初始不可手术切除患者的中位生存期分别为36、17个月,差异有统计学意义(χ^(2)=57.423,P<0.05)。转化治疗成功患者与未成功患者的中位生存期分别为20、15个月,差异有统计学意义(χ^(2)=4.487,P<0.05)。肝转移灶最大直径<6 cm及数目≤4个的患者转化率分别为50%(8/16)、50%(9/18),明显高于对照组的18%(4/22)、15%(3/20)(χ^(2)=4.340,5.371;P<0.05)。结论转化治疗可明显改善CRLM患者的生存预后,肝转移灶大小及数目是影响患者转化治疗结果的重要因素。以手术切除为主的综合治疗是提高CRLM患者疗效的关键。Objective To explore the value and influencing factors of conversion therapy in the treatment of patients with colorectal cancer liver metastasis(CRLM).Methods Clinical data of 78 CRLM patients admitted to Peking University People's Hospital from January 2011 to June 2019 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,51 patients were male and 27 female,aged 39-77 years with a median age of 58 years.According to the assessment result of liver metastases,primary resection of primary lesions and liver metastases combined with postoperative chemotherapy were performed in patients with initially resectable tumors.Patients with initially unresectable tumors were treated with conversion therapies of bevacizumab combined with XELOX regimen or cetuximab combined with FOLFIRI regimen.Patients who successfully received conversion therapy underwent surgery-based comprehensive treatments.Survival analysis was performed by Kaplan-Meier method and Log-rank test.The influencing factors of successful conversion therapy were analyzed by Chi-square test.Results 40 patients were diagnosed with initially resectable tumors and 38 cases of initially unresectable tumors.The success rate of CRLM conversion therapy was 32%(12/38),including 5 cases of hepatectomy,6 cases of hepatectomy combined with radiofrequency ablation,and 1 case of portal vein ligation and secondary hepatectomy.The median survival of patients with initially resectable and unresectable tumors was 36 and 17 months,respectively,where significant difference was observed(χ^(2)=57.423,P<0.05).The median survival of patients who received successful and unsuccessful conversion therapy was 20 and 15 months,respectively,where significant difference was observed(χ^(2)=4.487,P<0.05).The conversion rates of patients with the maximal diameter of liver metastases<6 cm and the number≤4 were 50%(8/16)and 50%(9/18),significantly higher than 18%(4/22)and 15%(3/20)in the control group

关 键 词：结直肠肿瘤 肿瘤转移 转化治疗 

分 类 号：R735.34[医药卫生—肿瘤]