结直肠癌肝转移的预后因素

Analysis of prognostic factors for colorectal liver metastases

目的:评价结直肠癌肝转移的临床预后因素及治疗方案对预后的影响.方法:收集71例结直肠癌肝转移患者的临床资料及预后情况,用Kaplan-Meier生存分析及Log-rank检验进行单因素分析,将有统计学意义的预后因素纳入Cox回归模型进行多因素分析.结果:Kaplan-Meier单因素分析及Log-rank检验显示,肝转移灶最大直径、有无区域淋巴结转移及诊断肝转移时碱性磷酸酶(ALP)最高值3个因素对其预后影响有显著意义;将这3个预后因素纳入Cox回归多因素分析显示,有无区域淋巴结转移、诊断肝转移时ALP最高值是结直肠癌肝转移的独立预后因素.全组3种治疗方式比较差别无统计学意义,但对手术切除组和化疗组两组进行比较,差异有统计学意义(P<0.05),而局部治疗组和手术组之间,局部治疗组和化疗组之间差别无统计学意义.结论:肝转移灶最大直径、原发病灶有无区域淋巴结转移、诊断肝转移时最高ALP值是结直肠癌肝转移患者的预后因素;肝转移灶最大直径越小、无区域淋巴结转移、诊断肝转移时最高ALP值正常的患者预后越好;手术切除联合化疗目前是结直肠癌肝转移的首选治疗方案,可获得较好的远期生存.

AIM： To evaluate the clinical prognostic factors for colorectal liver metastases and to analyze the impact of different treatments on prognosis. METHODS： The clinical and prognostic data for 71 patients with colorectal liver metastases were analyzed. Univariate analysis was performed using the Kaplan-Meier method and Log-rank test to find significant prognostic factors, while multivariate analysis was performed using the Cox regression model. RESULTS： Univariate analysis showed that the maximum diameter of liver metastases, presence or absence of regional lymph node metastasis and highest ALP level were significant prognostic factors. Cox multivariate regression analysis revealed that presence or absence of regional lymph node metastasis and highest ALP level were independent prognostic factors for colorectal liver metastases. The prognosis differed significantly between patients undergoing surgical resection and those undergoing chemotherapy （P = 0.049）, but showed no significant difference between patients undergoing local treatment and those undergoing surgical resection as well as between patients undergoing local treatment and those undergoing chemotherapy. CONCLUSION： The maximum diameter of liver metastases, presence or absence of regional lymph node metastasis, and highest ALP level are significant prognostic factors for colorectal liver metastases. Curative surgical resection combined with chemotherapy is the preferred treatment option for colorectal liver metastases since it was associated with better long-term survival.