结直肠癌肝转移患者行肝根治性切除术的预后影响因素分析

Analysis of prognostic factors for patients treated by radical resection of liver metastases from colorectal cancer

目的探讨结直肠癌肝转移患者行肝根治性切除手术预后的影响因素及临床意义。方法回顾性分析北京怀柔医院2003年1月-2008年3月收治的182例行根治性切除的结直肠癌肝转移患者,分析临床病理因素与疗效的关系。Kaplan-Meier法计算生存率,单因素分析采用Log-rank法,多因素分析采用Cox比例风险模型。结果 182例患者均获得随访,随访时间为9~60个月,患者1、3、5年生存率分别为82.96%、59.73%、40.11%。单因素分析显示,转移瘤的大小、分布、数目、术前血清癌胚抗原（CEA）水平、有无并发症、术后有无辅助性治疗等是影响结直肠癌肝转移患者行肝根治性切除预后的影响因素（χ2值分别为4.598、4.653、5.327、4.768、5.502、4.546,P值均〈0.05）。多因素分析显示,转移瘤的数目、术前CEA水平、术后有无并发症是影响患者预后的独立危险因素（Wald值分别为5.155、5.905、8.343,P值均〈0.05）。结论转移瘤的数目、术前CEA水平、术后有无并发症是影响患者预后的独立危险因素。对患者扩大手术切除的适应证,术后对患者积极进行辅助治疗,可以有效改善患者的预后。

Objective To explore the prognostic factors for patients treated by radical resection of the liver metastases from colorectal cancer and to analyze the significance of these factors. Methods The clinical and pathological data concerning 182 patients with liver metastases from colorectal cancer, who were admitted to our hospital from January 2003 to March 2008, were retrospectively analyzed, and the relationship between clinicopathological factors and treatment outcome was analyzed. The survival rate was calculated by the Kaplan - Meier method ; univariate prognostic analysis was performed using the logrank test; multivariate prognostic analysis was performed using the Cox proportional hazards model. Results Follow - up visits were carried out in all patients, with a follow - up period ranging from 9 to 60 months. The 1 - , 3 - , and 5 - year survival rates were 82.96% , 59.73 % , and 40.11% , respectively. Univariate analysis revealed that the number, size, and distribution of metastatic tumors, preoperative serum carcinoembryonic antigen （CEA） concentration, complications, and postoperative auxiliary therapy were prognostic factors for patients treated by radical resection of the liver metastases from colorectal cancer （X2 = 4. 598,4. 653,5. 327,4. 768,5. 502,4. 546, all P 〈 0.05 ）. Multivariate analysis confirmed that the number of liver metastases, preoperative serum CEA concentration, and postoperative complications were regarded as independent predictors of survival （Wald = 5. 155, 5. 905, and 8. 343, P 〈 0.05）. Conclusion The number of liver metastases, preoperative serum CEA concentration, and postoperative complications are independent predictors of survival. Expanding indications for surgical resection and active postoperative auxiliary therapy are crucial to increase the survival rate after radical resection of liver metastases from colorectal carcinoma.