结直肠癌肝转移治疗1O年随访：单中心120例分析

Colorectal liver metastases： a retrospective analysis of 120 patients from a single-institution

目的比较射频消融（RFA）与手术切除治疗结直肠癌肝转移的效果，探讨影响预后的相关因素。方法回顾性分析2004年1月至2009年5月第三军医大学西南医院全军肝胆外科研究所收治的120例结直肠癌肝转移患者临床病理资料和随访资料，对患者术后的相关参数进行统计学对比分析。结果120例肝转移患者RFA治疗62例，手术治疗58例。两组均无围手术期死亡。RFA术后并发症较手术组低，差异有统计学意义（9．7％比24．1％，X2=4．512，P〈0．05）。转移癌直径〈4．0em者两组复发率及1、3、5年生存率差异无统计学意义（21．4％比10．0％，X2=2．413，P〉0．05；X2=2．248，P〉0．05）。转移癌直径≥4．0em者复发率及1、3、5年生存率之间差异均有统计学意义（37．5％比26．3％，X2=4．992，P〈0．05；X2=4．370，P〈0．05）。至2014年5月108例患者获得为期7～81个月的随访，总体中位生存时间37个月。单因素分析结果显示原发灶分化程度、原发灶N分期、转移癌直径、转移癌类型、肝外转移及癌胚抗原（CEA）水平与结直肠癌肝转移的预后相关（P〈0．05）。多因素分析结果显示转移癌类型、转移癌直径、肝外转移及高CEA水平是影响结直肠癌肝转移总生存时间的独立危险因素（OR=2．414，2．560，1．964，1．998；95％CI：1．179—2．778，1．420—4．615，1．269—3．041，1．295～3．084；P〈0．05）。结论RFA适合结直肠癌肝转移的治疗，临床病例选择应严格。转移癌类型、转移癌直径、肝外转移、高CEA水平是影响结直肠癌肝转移总体生存率的独立危险因素。

Objective To evaluate the clinical efficacy of radiofrequency ablation（RFA） and surgi- cal treatment of colorectal liver metastases, and to explore the prognostic factors for patients with colorectal liver metastases. Methods The clinicopathological data of 120 patients with colorectal liver metastases who underwent surgical treatment or RFA at the Southwest Hospital from January 2004 to May 2009 were analyzed retrospectively. The postoperative clinical data and follow-up data were statistically analyzed. The follow-up was censored in May 2014. Results Of 120 patients, 62 received RFA and 58 received surgical treatment. No patient died perioperatively. There was a significantly lower postoperative complication rate in the RFA group than in the surgical treatment group （9. 7% vs 24.1%, X2 =4.512, P 〈0.05）. There was no signif- icant difference in recurrence rate and in the 1-, 3-, 5-year survival rates in patients with metastatic carcino- ma of 〈4.0 cm in diameter （21.4% vs 10.0% , X2 =2.413, P〉0.05; X2 =2.248, P〉0.05） , but the difference was significant in patients with metastatic carcinoma of ≥ 4. 0 cm in diameter （37.5% vs 26. 3% , X2 = 4. 992, P 〈 0.05 ; X2 = 4. 370, P 〈 0.05 ）. 108 patients were followed up for 7 - 81 months. The overall median survival was 37 months. Univariate analysis showed differentiation and N staging of the primary tumor, diameter and type of metastases, extrahepatic metastasis, and a high serum carcinoembryonie antigen （CEA） level correlated with prognosis of patients with colorectal liver metastases （ P 〈 0.05 ）. On multivariate analysis, diameter and type of metastases, extrahepatie metastasis, and a high serum CEA were independent predictors of overall survival （ OR = 2. 414, 2. 560, 1. 964, 1. 998 ; 95% CI： 1. 179 - 2. 778, 1.420~4.615, 1.269 ~3.041, 1.295 ~3.084; P〈0.05）. Conclusions RFA can be used in patients with colorectal liver metastases, but these patients should be selected strictly. The type and diameter of me- tastases, extrahepatic metastasis, and a high serum CEA were independent predictors of overall survival for patients with colorectal liver metastases.