结直肠癌远处转移的生存分析及M1分期细化研究

Survival analysis and recommendation of subdividing M1 stage according to metastatic status of colorectal cancer

目的探讨结直肠癌远处转移患者的M1分期细化，以更加准确的指导发生远处转移的结直肠癌患者的个体化治疗。方法随访1995年1月至2010年12月期间在中山大学附属肿瘤医院治疗的结直肠癌远处转移患者666例，分析转移部位，转移灶的数目，转移瘤的大小及其相应治疗方式等因素与转移性结直肠癌患者的生存相关性，对预后因素进行单因素及多因素分析。结果肝转移与非肝转移者的转移后中位生存期分别为18．7个月比22．9个月（P=0．082）。单器官转移、双器官转移和多器官转移的转移后中位生存期分别为24．8个月比15．6个月比10．9个月，（P〈0．01）。手术或消融治疗联合全身静脉化疗的结直肠肝转移患者的转移后中位生存时间较单纯化疗者长（49．6个月比22．3个月，P〈0．01）。结论不同临床特征和治疗方式的结直肠癌远处转移患者的预后明显不同，根据其转移特征，进行M1分期细化，区分其中具有较好预后的患者，采用个体化治疗方法，有望通过积极治疗获得长期生存。

Objective To subdivide the M1 stage of patients to predict better survival groups and assess the predictive factors of prognosis to select personalized cancer treatments. Methods From the records of 666 eoloreetal cancer cases treated at our hospital during January 1995 to December 2010, we analyzed the site of metastases, number of metastases, size of hepatic metastatic tumor and corresponding treatments. According to the results, we made recommendations for subdividing the M1 stage to guide individualized treatments. Results The metastatic median survival of liver metastasis and non-liver metastasis were 18. 7 vs 22. 9 months （P = 0. 082 ）. And the median survival of single organ metastasis, double organ metastasis and multiple organ metastasis were 24. 8 vs 15.6 vs 10.9 months, （P 〈 0. 01 ）. With no more than 3 liver lesions, the patients received operation or ablation therapy plus chemotherapy and their median survival was longer than those on chemotherapy only （49. 6 vs 22. 3 months, P 〈 0. 01 ）. Conclusion According to metastatic characteristics, different clinical features and treatments result in significantly different survivals and prognoses in metastatic eoloreetal cancer patients.