肝动脉化疗栓塞治疗结直肠癌肝转移的疗效和预后影响因素

Evaluation of the efficacy and prognostic factors for colorectal liver metastases treated with transcatheter arterial chemoembolization

目的评价肝动脉化疗栓塞（TACE）治疗结直肠癌肝转移患者的疗效和价值，并探讨影响预后的因素。方法回顾性分析2002年1月至2008年12月期间183例接受TACE治疗的结直肠癌肝转移患者的生存结果，以Logrank法分析影响预后的因素，以Cox比例风险模型确定独立的危险因素。结果183例结直肠癌肝转移患者经TACE治疗后的中位生存时间为22个月，0．5、1、2、3和5年生存率分别为93．9％、81．1％、39．8％、18．2％和3．9％。肝转移瘤累及多叶、癌胚抗原（CEA）和糖类抗原19-9（CA19-9）水平升高是影响患者预后的独立危险因素（均P〈0．01）；而女性患者、TACE治疗〉2次、联合局部治疗、治疗后行Ⅱ期手术是具有保护性的独立预后因素（均P〈0．01）。结论对于无法手术切除的结直肠癌肝转移患者，TACE是有效的治疗方法。接受多次TACE、联合局部治疗、治疗后行Ⅱ期手术有助于提高结直肠癌肝转移患者的疗效，延长患者的生存时间。

Objective The aim of this study was to evaluate the therapeutic efficacy and to determine the prognostic factors of TACE in patients with colorectal liver metastases （CRLM）. Methods The clinical data of 183 patients with unresectable CRLM treated with TACE from Jan. 2002 to Dec. 2008 were retrospectively reviewed. Log-rank method was used for univariate analysis and Cox proportional hazard model was used for multivariate analysis of the prognostic factors. Results The median survival time was 22 months, and the 0.5-, 1-, 2-, 3-, 5-year survival rates were 93.9% , 81.1% , 39.8% , 18.2% , and 3.9% , respectively. Multivariate analysis showed that tumor involved more than one lobe of the liver, and elevated CEA and CA19-9 levels were independent risk factors for the overall survival （P 〈 0.01 ）. Females, more times of TACE, combination with regional therapy and received phase Ⅱ resection were related with a good survival （ P 〈 0. 01 ） in CRLM patients after TACE treatment. Conclusions Transcatheter arterial chemoembolization is an effective therapy for unresectable colorectal liver metastases. Patients with tumor spread more than one lobe of the liver, high CEA and CA19-9 levels are independent poor prognostic factors. Females, patients received more times of TACE, combined with regional therapy and received phase Ⅱ resection may have a good survival.