结直肠癌同时性肝转移不同治疗方法的预后因素分析

Prognostic analysis of different treatments for synchronous colorectal liver metastasis

目的评价不同治疗方案对结直肠癌同时性肝转移患者预后的影响。方法回顾性分析新疆医科大学第一附属医院2010年1月至2014年12月收治的121例结直肠癌同时性肝转移患者的临床病理资料，针对转移灶将患者分为单纯手术组（22例）、单纯化疗组（43例）和以手术为基础的联合治疗组（56例），分析3组患者预后情况，并通过Log—rank检验和Cox风险比例模型对影响预后的相关因素进行单因素和多因素分析。结果单纯手术组中位生存期为10（3～39）月。单纯化疗组为7（3～36）月，联合治疗组为18（4～66）月，3组比较，差异有统计学意义（P〈0．05）。淋巴结转移程度、肝转移灶数目、肝转移灶直径、肝转移灶切缘范围和治疗方法是影响结直肠癌同时性肝转移预后的独立因素（均P〈0．05）。结论多种方法的联合治疗可以延长结直肠癌同时性肝转移患者的生存期。

Objective To evaluate the effects of different treatments on the prognosis of patients with synchronous coloreetal liver metastasis （CLM）. Methods Clinicopathologieal data of 121 patients with synchronous CLM in The First Affiliated Hospital of Xinjiang Medical University between January 2010 and December 2014 were retrospectively analyzed. According to the metastatic lesions, patients were divided into simple operation group （22 patients, receiving operation only）, simple chemotherapy group （43 patients, receiving chemotherapy only）, and combination group （56 patients, receiving chemotherapy based on operation）. The prognosis of patients in three groups was investigated. Univariate and multivariate analyses were performed through the long-rank test and Cox model to evaluate the related factors affecting prognosis. Results The median survival time was 10 （3-39） months in simple operation group, 7（3-36） months in simple chemotherapy group, and 18 （4-66） months in combination group. The differences among groups were all statistically significant （all P〈0.05）. Extent of lymph node metastasis, number of liver metastatic lesion, size of liver metastatic lesion, resection edge extent of liver metastatic lesion, and treatment method were independent factors of synchronous CLM （all P〈 0.05）. Conclusion Combination therapy of a variety of treatment can prolong the survival of patients with synchronous CLM.