摘要
目的评价手术治疗对结直肠癌肝转移病人生存率的影响。方法回顾分析2000年1月1日至2004年12月31日复旦大学附属中山医院收治的363例结直肠癌肝转移病人,其中91例为手术病例,评价手术治疗对生存率的影响。结果160例同时性肝转移病人中手术切除肝转移灶22例(13.8%),203例延时性肝转移病人中手术切除肝转移灶69例(34.0%),两者相比差异具有统计学意义(P〈0.000)。同时性肝转移组手术死亡率(4.5%,1/22)高于延时性肝转移组(2.8%,2/69),两者相比差异有统计学意义(P〈0.05)。以2005年6月31日为随访终点,91例病人随访率100%,手术病人中同时性肝转移组1、3、5年生存率和中位生存时间与延时性肝转移组相似(P〉0.05),但术后复发率较高(36.4%vs21.7%,P=0.03)。363例病人中有36例具有手术指征而未手术病例,其1、3、5年生存率分别为47.9%、5.34%和0,明显低于91例手术病例(80.5%、33.0%和22.7%),(P=0.0034)。应用COX比例风险模型,对所有91例手术病人影响生存的因素进行多因素风险分析,得出手术切缘达1cm(β=-0.8351,P=0.0363)和复发后再次手术(β=-0.9428,P=0.0411)是生存的保护性因素,而术后复发(β=0.6471,P=0.0226)是生存的危险因素。结论手术治疗是结直肠癌肝转移的首选治疗措施,可以明显提高病人的术后生存。
Objective To investigate the relation of hepatic resection to survival rate of patients with liver metastasis of colorectal cancer (LMCC). Methods The retrograde analysis was conducted for 91 patients with LMCC received hepatic resection from January 2000 to December 2004 in our hospital Results Ninety-one of all the 363 with LMCC underwent hepatic resection. Of the 91 patients, 22 (22/160, 13.8%) belonged to the synchronous liver metastasis (SLM) group and 69 (69/203, 34. 0%) to the metachronous liver metastasis (MLM) group (P〈0. 000). The mortality related to operation was 4. 5% (1/22) in SLM group and 2. 8% (2/69) in MLM group (P〈0. 05). All the 91 patients were followed up till the end of June 2005. The 1-, 3- and 5-year survival rates and median survival time in SLM (90. 4%, 32. 5%, 16. 3%, 23 months) were similar to those in MLM (80. 5%, 33.0%, 24. 3%, 26 months) (P〉0. 05). However, the recurrent rate was significantly higher in SLM than in MLM (36.4% vs. 21.7%, P=0. 03). The 1-, 3- and 5-year survival rates were markedly higher in the 91 patients than in the 36 whose liver metastatic foci can be resected receiving non-operative therapy (80.3%, 33.0%, 22.7% vs. 47.9 %, 5.34%, 0, P=0.0034). COX multivariate analysis was used to analyze the prognosis factors. Incision margin ≥ 1 cm(β=-0. 8351, P= 0. 0363) and reoperation after recurrence (β=-0. 9428, P= 0. 0411) were protective survival factors and postoperative recurrence (β=0. 6471,P=0. 0226) was the survival risk factor. Conclusions Curative hepatic resection is the first choice for LMCC and can improve survival of the patients.
出处
《中华肝胆外科杂志》
CAS
CSCD
2007年第2期104-107,共4页
Chinese Journal of Hepatobiliary Surgery
关键词
结肠肿瘤
直肠肿瘤
肝转移
手术
生存率
Colonic neoplasms
Rectal neoplasms
Liver metastasis
Hepatic resection
Survival