不同治疗方法对363例结直肠癌肝转移患者生存的影响

Survival of patients with liver metastasis from colorectal cancer by different modes of therapy： a report of 363 cases

目的评价不同治疗方法以及肝转移发生时间对结直肠癌肝转移患者生存率的影响。方法回顾性分析363例结直肠癌肝转移患者的病史特征，随访其生存结果。结果363例患者中，同时性肝转移160例，延时性肝转移203例，发生肝转移的中位时间为（15．0±14．7）个月。同时性肝转移组和延时性肝转移组在性别、年龄和肠道原发病灶部位的差异无统计学意义，而肝转移灶特征（累及肝叶类型、病灶个数和病灶直径）和术前CEA、CAl9-9水平差异有显著统计学意义。手术切除肝转移灶9l例，其中同时性肝转移组22例，延时性肝转移组69例，手术死亡率分别为4．5％（1／22）和2．9％（2／69），差异有统计学意义（P〈0．05）。以2005年6月31日为随访终点，随访率100％。同时性肝转移组和延时性肝转移组患者的中位生存时间分别是（10±1）个月和（17±1）个月，差异有统计学意义（P〈0．01），3年生存率分别为5．2％和16．4％（P〈0．01）；手术与各种非手术治疗（介入、化疗、射频、无水酒精注射和中医中药）患者的中位生存期分别为26个月和10-17个月（P〈0．01），3年生存率分别为30．2％和0％-16．7％（P〈0．05）。结论手术治疗仍是结直肠癌肝转移患者的首选治疗方法，其他非手术治疗方法可以提高二期手术切除率。延时性肝转移患者的手术切除率和生存率均明显高于同时性肝转移患者。

Objective To evaluate the correlation between different therapies and survival of liver metastasis from colorectal cancer （LMCC）, and to compare the clinical outcome of synchronous liver metastasis （SLM） with that of metachronous liver metastasis （MLM）. Methods The clinical data of 363 patients with LMCC were retrospectively reviewed with focus on the correlation between different therapy and survival. Results Of these 363 patients, 160 had SLM and 203 had MLM. Between the SLM and MLM group, there was no significant difference in age, or gender or primary cancer site （ P 〉 0. 05 ） , but significant differences were observed in condition of liver metastasis including liver lobe involved, focus number, maximum focus diameters and level of serum CEA and CA199 before therapy（P 〈0.05 ）. Ninetyone patients underwent curative hepatic resection, 22 of them in the SLM group and 69 in the MLM group. Mortality rate related to operation was 4.5% （1/22） in SLM group and 2.9% （ 2/69 ） in MLM group （ P 〈 0.05）. All patients were followed until 31/6/2005. The 3-year survival rate was 5.2% with a median survival time of 10 ± 1 months for the SLM group, and it wasl6.4% and 17 ± 1 months for the MLM group （P 〈0.01 ）. Regarding to the treatment modalities, the 3-year survival rate was 30. 2% with a median survival time of 26 months for curative hepatic resection group, and it was 0% - 16.7% and 10 - 17 months for non-operation groups treated by intervention, chemotherapy, radiofrequency therapy, percutaneous ethanol injection and Chinese traditional drugs （ P 〈 0.05, P 〈 0.01 ）. Conclusion Curative hepatic resection is still the first choice for liver metastasis from colorectal cancer improving the survival significantly. Other non-operative methods also can improve phase Ⅱ resection rate. metastasis has higher resection rate and better survival than the synchronous liver one.