手术切除在结直肠癌肝转移治疗中的意义及预后

Surgical treatment and prognosis of colorectal liver metastases

目的探讨手术切除对结直肠癌肝转移的疗效及预后影响因素。方法回顾性分析施行肝切除术的35例结直肠癌肝转移患者的临床及随访资料。Kaplane-Meier法分析生存率。多因素预后分析采用Cox逐步回归法。结果全组总的1、3和5年累计生存率分别为93.5%、68.5%和39.9%。单因素分析显示转移瘤最大直径、手术切缘、淋巴结转移、肝转移类型及转移瘤病理分化程度对生存率有显著影响;多因素分析显示肝转移瘤最大直径(P=0.012)、手术切缘(P=0.027)是影响生存率的独立因素。结论结直肠癌肝转移的外科治疗可使患者获得长期生存。最大转移瘤直径小于5.0cm、手术切缘阴性预示结直肠癌肝转移手术切除预后较好。

Objective To evaluate the curative effect and prognosis of hepatic resection for colorectal liver metastases （CLM）. Methods Thirty-five cases of CLM were treated with hepatectomy from Jan. 1999 to Feb. 2006. Clinical and follow-up data of these cases were analyzed retrospectively. The cumulative survival rate was analyzed by Kaplane-Meier method. Multiple factor analysis was introduced by Cox＇s proportional hazard model. Results The survival rates of overall 1-, 3-, and 5-year were 93.5%, 68.5% and 39.9%, respectively. According to univariate analysis, the survival rate was affected by tumor size, surgical margin, lymphatic metastasis, type of liver metastases, metastatic carcinoma differentiation significantly （P〈0.05）. Multiple factor analysis revealed that tumor size （P=0.012）, incisal margin （P=0.027） were independent factors on survival rate. Condusions Hepatectomy can prolong survival time of patients with CLM. Either tumor size of 〈5cm or negative incisal margin predicts a better survival.