结直肠癌肝转移患者术后早期复发的高危因素分析  

High-risk factors for early postoperative recurrence in patients with colorectal cancer liver metastasis

作　　者：沈雷斌 杨沔 金梁斌 彭涛[1] 周波[1] 孙佳泽 俞甲子 Shen Leibin;Yang Mian;Jin Liangbin;Peng Tao;Zhou Bo;Sun Jiaze;Yu Jiazi(Department of Colo-Anorectal Surgery,the Affiliated Li Huili Hospital of Ningbo University,Ningbo 315020,China)

机构地区：[1]宁波大学附属李惠利医院结肠肛肠外科,宁波315020

出　　处：《中华普通外科杂志》2025年第3期207-212,共6页Chinese Journal of General Surgery

基　　金：浙江省医药卫生科技计划项目(2024KY296)。

摘　　要：目的探讨结直肠癌肝转移(colorectal cancer liver metastasis,CRLM)患者术后早期复发的高危因素。方法回顾性分析2015年1月至2021年12月期间于宁波大学附属李惠利医院接受肝转移瘤切除手术治疗的156例CRLM患者的临床资料。结果在156例CRLM患者中,术后复发率为55.8%(87/156)。单因素分析显示原发肿瘤部位、T分期、肿瘤负荷评分(tumor burden score,TBS)、术前CEA、CA199和CA125浓度、最大转移瘤直径及转移瘤数量在1年内复发组与未复发组之间差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,术前CA125浓度(OR=1.021,P=0.020)、CEA浓度(OR=1.044,P=0.018)和TBS评分(OR=3.067,P=0.011)是影响早期复发的危险因素(P<0.05)。将患者分为低分组(TBS≤4)和高分组(TBS>4),在低TBS评分组中,同期切除49例,1年内复发13例,复发率为26.5%;而二期切除的29例中,1年内复发17例,复发率为58.6%(P<0.05)。在高TBS评分组中,同期切除51例,1年内复发37例,复发率为72.5%;而二期切除的27例中,1年内复发20例,复发率为74.1%,差异无统计学意义(P>0.05)。结论术前TBS评分、术前CA125浓度和CEA浓度是CRLM患者术后早期复发的高危因素,低TBS分期患者中采用同期切除的手术方式可有效降低术后1年内复发风险。Objective To investigate the high-risk factors for early postoperative recurrence in patients with colorectal cancer liver metastasis(CRLM).Methods The clinical data of 156 CRLM patients who underwent hepatic metastasectomy at the Li Huili Hospital,Ningbo University from Jan 2015 to Dec 2021 was retrospectively analyzed.Results Among 156 patients,the postoperative recurrence rate was 55.8%(87/156).There were significant differences(P<0.05)in the primary tumor site,T stage,TBS score,preoperative concentrations of CEA,CA199 and CA125,the maximum diameter of metastatic tumors and the number of metastatic tumors between the group with recurrence in one year and the group without recurrence in one year.Multivariate analysis showed that preoperative CA125 concentration(OR=1.021,P=0.020),CEA concentration(OR=1.044,P=0.018),and tumor burden score(OR=3.067,P=0.011)were high risk factors influencing early recurrence(P<0.05).In the low TBS score group(≤4),among the 49 patients who underwent simultaneous resection,13 suffered from recurrence within 1 year,with a recurrence rate of 26.5%.Meanwhile,among the 29 patients who underwent staged resection,17 suffered from recurrence within 1 year,with a recurrence rate of 58.6%(P<0.05).In the high TBS score group(>4),among the 51 patients who underwent simultaneous resection,37 suffered from recurrence within 1 year,with a recurrence rate of 72.5%,while in the 27 patients who underwent staged resection,20 suffered from recurrence within 1 year,with a recurrence rate of 74.1%(P>0.05).Conclusions Preoperative TBS score,preoperative CA125 concentration,and CEA concentration are high-risk factors for postoperative recurrence in patients with colorectal liver metastases,simultaneous resection in patients with a low TBS score can reduce the risk of recurrence within 1 year after surgery.

关 键 词：结肠肿瘤 直肠肿瘤 肝转移 术后复发 危险因素 

分 类 号：R73[医药卫生—肿瘤]