多学科团队模式下结直肠癌肝转移的转化性治疗(附86例报告)

Multi-disciplinary team and conversion therapy for colorectal cancer with unresectable liver metastases:A report of 86 patients

目的探索适用于初始不可切除的结直肠癌肝转移（colorectal liver metastases,CLMs）病人转化性治疗的多学科团队（MDT）模式,评价转化性治疗的安全性和有效性。方法回顾性分析2008年1月至2011年12月复旦大学附属中山医院经过MDT诊治模式并转化性治疗成功的86例CLMs病人的临床资料,评价MDT诊治模式下转化性治疗的实施及近远期疗效,并分析预测病人预后的因素。结果 86例病人随访41.0（24~68）个月,转移灶复发73例,39例死亡。病人的1、2、3年累积总存活率（OS）分别为90.6%、75.6%、65.1%;中位生存时间为（47.5±3.1）个月。1、2、3年无疾病存活率（DFS）分别为72.1%、48.8%、31.4%,中位DFS时间（22.0±2.9）个月,与99例初始可切除性CLMs的OS和DFS相比差异无统计学意义（P〉0.05）。86例病人围手术期病死率1.5%,手术并发症发生率24.4%且经过积极支持治疗后均痊愈。肿瘤缓解程度与早期肿瘤退缩对转化性治疗病人的预后有预测作用。结论对于不可切除的CLMs,MDT指导下的转化性治疗安全、有效,转化治疗成功病人的中期生存效果与初始可切除性CLMs相似,长期生存效果值得期待。

Objective To analyze safety and effect of the conversion therapy for initially unresectable colorectal liver metastases（CLMs） under the guidance of multi-disciplinary team（MDT）.Methods The retrospective analysis was conducted for 86 patients with unresectable CLMs received MDT management and arrived conversion therapy successfully from January 2008 to December 2011 in Zhongshan Hospital of Fudan University. The perioperative and survival outcomes,prognostic factors were evaluated.Results During the mean follow-up of 41 months（24-68months）, according to the finding time of liver metastases of 86 patients,recurrence events were 73 patients,and 39 patients died. The 1 year,2 year and 3 year overall survival rate（OS） was 90.6%,75.6% and 65.1% respectively. The median OS time was（47.5±3.1）months. The 1 year,2 year and 3 year disease free survival rate（DFS） was 72.1%,48.8% and 31.4% respectively. The median DFS time was（22.0±2.9）months. The OS and DFS were no significant difference when compared 86 patients with initially unresectable CLMs successfully arrived conversion therapy with 99 patients with initial resectable CLMs（P〉0.05）. The perioperative mortality rate was 1.5%,and operative complication rate was 24.4%. Tumor regression grade and early tumor shrink could predict the prognosis of CLM patients received conversion therapy.Conclusion The conversion therapy under the guidance of MDT mode is safe and effective for unresectable CLMs. The mid-term survival rate is similar with initially resectable CLMs,and long-term survival is expected.