77例直肠癌伴肝转移患者的预后因素分析

Prognostic analysis of 77 cases of rectal cancer with synchronous liver metastases

目的 探讨影响直肠癌伴肝转移患者预后的相关因素.方法 回顾性分析77例直肠癌伴肝转移患者的临床病理资料,以Kaplan-Meier法分析患者的总生存率,以Log rank检验和Cox模型对影响患者生存的临床病理因素进行单因素和多因素分析.结果 全组患者的中位生存时间为12个月,1、2、3和5年生存率分别为47.7%、28.0%、13.1%和1.5%.单因素分析结果显示,原发肿瘤的分化程度越低、肠壁浸润程度越深、有淋巴结转移、肝转移灶分布于双叶、肝转移灶数目＞1个、肝转移灶的最大直径＞5 cm、有肝外受侵或转移、确诊时癌胚抗原（CEA）≥5 ng/ml以及未行根治性手术者的预后较差（均P＜0.05）.多因素分析结果显示,原发肿瘤的分化程度（P=0.007）、肠壁浸润深度（P=0.027）、肝转移灶的最大直径（P=0.003）以及确诊时的CEA水平（P=0.000）为影响直肠癌伴肝转移患者预后的独立因素.结论 对于直肠癌伴肝转移的患者,原发肿瘤的分化程度越高、肠壁浸润越浅、肝转移灶的最大直径越小以及确诊时CEA水平越低,患者的预后越好.

Objective To explore the prognostic factors for rectal cancer patients with synchronous liver metastases. Methods Data from a total of 77 cases of rectal cancer with synchronous liver metastases treated in our center from January 2002 to December 2008 were collected and reviewed. The total survival rate was analyzed by Kaplan-Meier method. Log-rank test and Cox regression model with SPSS17.0 software were used to analyze 13 factors including clinicopathological factors and treatment choices. Results The median survival time of the 77 cases was 12 months. The 1-, 2-, 3-and 5-year survival rates were 47.7%,28.0% , 13.1 %, and 1.5% , respectively. Univariate analysis with Kaplan-Meier method revealed that the differentiation of the primary tumor, T-stage, N status, the distribution, number and size of liver metastases,extrahepatic disease, serum CEA level at diagnosis and treatment modality were prognostic factors （ P 〈0.05 ）. Multivariate analysis showed that the differentiation of the primary tumor（ P = 0. 007 ）, T-stage（ P =0.027 ） , the size of liver metastases （ P = 0. 003 ）, serum CEA value at diagnosis （ P = 0.000 ） were independent prognostic factors for rectal cancer patients with synchronous liver metastases. Conclusion The factors affecting the prognosis for rectal cancer patients with synchronous liver metastases are the differentiation of the primary tumor, T-stage, N status, the distribution, number and size of liver metastases,extrahepatic disease, serum CEA level at diagnosis and treatment modality. The differentiation of the primary tumor, T-stage, the size of liver metastases, and serum CEA value at diagnosis are independent prongostic factors.