结直肠癌肝转移患者临床风险评分体系的预后评价

Prognostic evaluation of clinical scoring systems for patients undergoing resection of colorectal cancer liver metastases

目的 探讨影响结直肠癌肝转移外科手术治疗预后的风险因素,验证现有风险评分的临床使用价值.方法 回顾性分析北京肿瘤医院肝胆胰外一科2000年1月至2014年8月行肝切除手术治疗的303例结直肠癌肝转移患者的临床资料及术后随访情况,进行生存状况分析.采用单因素和Cox比例风险回归模型等分析影响结直肠癌肝转移患者生存的相关因素,验证目前广泛应用的5种临床风险评分体系对患者生存预测的准确性.结果 全组患者1、3、5年总生存率分别为89.2％、50.8％、38.6％.中位生存期37个月.原发灶N分期和肝切除术前癌胚抗原（CEA）水平是影响预后的独立危险因素.MSKCC评分对患者术后总生存的预测效果最优（C-index：0.903）.结论 结直肠癌肝转移患者术后生存受多种风险因素影响,现有的5种预后评分体系中MSKCC评分预测效果最优.

Objective To identify the risk factors associated with overall survival （OS） for patients undergoing partial hepatectomy for colorectal liver metastases,and to assess the predictive values of five published scoring systems in an independent patient cohort for the purpose of external validation.Methods The clinical,pathologic,and complete follow-up data were prospectively collected from 303 consecutive patients who underwent primary hepatic resection for colorectal liver metastases at the Beijing Cancer Hospital from January 2000 to Aug 2014.The predictive values of the Nordlinger score,the Memorial Sloan-Kettering Cancer Center （MSKCC） score,the Iwatsuki score,the Basingstoke index,and the Konopke scoring system were assessed in this patient set.The clinical and pathologic parameters were further analyzed using univariate and multivariate analyses.Results The 1-,3-and 5-year overall survival were 89.2％,50.8％ and 38.6％,respectively.The median survival time was 37 months.Two risk factors were found to be independent predictors of poor overall survival：the N stage of the primary tumor,and a carcinoembyonic antigen level ＞ 30 μg/L.The MSKCC score had the best independent predictive power for survival when compared with the other 4 prognostic systems （C-index：0.903）.Conclusion In our patient cohort,the MSKCC score was the best staging system in predicting survival.