不同治疗方法对结直肠癌肝转移患者预后的影响

Prognostic analysis of patients with liver metastases from colorectal cancer treated with different modes of therapy

目的探讨不同治疗方法对结直肠癌肝转移患者预后的影响。方法对300例结直肠癌首发肝转移患者的诊治过程及肝转移后生存情况进行回顾性分析。结果结直肠癌肝转移灶完全切除者、姑息切除者和无法切除者的肝转移后中位生存期分别为48、19和18个月（P=0．000）。对于无法行肝转移灶完全切除的患者，肝转移后化疗联合局部治疗和不治疗患者的肝转移后中位生存期分别为23个月和6个月（P=0．000）。一线治疗有效患者和无效患者的肝转移后中位生存期分别为24个月和16个月（P=0．000）。单因素生存分析结果显示，原发肿瘤的治疗方式、肝转移灶的手术方式、肝转移后的综合治疗以及一线治疗的疗效均与预后相关（均P〈0．05）。多因素分析结果显示，肝转移灶的手术方式、肝转移后的综合治疗和肝转移后一线治疗的疗效是影响结直肠癌肝转移患者预后的独立因素（P〈0．05）。结论肝转移灶完全切除、肝转移后进行综合治疗以及肝转移后一线治疗有效的结直肠癌肝转移患者预后好。

Objective To investigate the potential prognostic factors for patients with liver metastases from colorectal cnaeer treated with different modes of therpy. Methods The clinicopathological data of 300 patients with liver metastases from colorectal cancers were retrospectively reviewed and analyzed. Results The median survival of patients with recurrence （ MSR ） treated with complete and palliative resection of liver metastases and unresectable patients was 48, 19 and 18 months, respectively （P = 0.000）. In patients with unresectable liver metastases, systemic chemotherapy plus regional therapy demonstrated a median survival time of 23 months, significantly longer than the 6 months in untreated patients （P = 0. 000 ）. Patients who showed response to the first-line therapy demonstrated an improved survival versus the patients who had no response, with a medain survival time of 24 vs. 16 months （ P = 0.000）. Univariate analysis revealed that resection modes of primary diseases and liver metastases, treatment modality for liver metastases, and response to first-line therapy were prognostic factors. Multivariate analysis showed that resection modes of liver metastases, muhimodality treatment after liver metastases, and the response to first-line therapy were all independent prognostic factors for patients with liver metastases from coloreetal cancer. Conclusion Resection of liver metastases, multimodality treatment after liver metastases, and response to first-line chemotherapy are all independent prognostic factors for patients with liver metastasis from colorectal cancer.