大肠癌肝脏转移患者同期外科治疗的远期生存状况分析

Survival Analysis of Colorectal Cancer Patients with Liver Metastasis

目的通过比较同期外科切除的大肠癌肝脏转移患者的临床资料,研究影响其远期生存状况的相关因素。方法回顾性分析2009年1月至2010年12月于我院行同期手术切除的70例大肠癌肝脏转移患者的完整临床资料,观察患者术后的短期及长期疗效,采用单因素与多因素回归分析,研究70例结直肠癌肝转移患者的5年生存情况及影响其远期生存的相关因素。结果本组患者术后30 d无死亡,其中位生存时间为46个月,1年生存率为78.57%,2年生存率为55.71%,3年生存率为48.57%,5年生存率为42.86%;全部70例患者有66例的肝转移灶获得R0切除,包括52例楔形切除、13例半肝切除以及1例扩大切除;另4例为R1切除。并发症共发生9例,占12.86%。单因素分析显示淋巴结转移、术前化疗、肝转移病灶数、肝转移最大直径、癌胚抗原水平以及糖链抗原199对患者的生存率有影响(P<0.05),而年龄、性别、原发瘤位置、肿瘤类型、病理类型、肝转移灶分布对患者的生存率无影响(P>0.05)。多因素分析结果显示,淋巴结转移、术前化疗、肝转移病灶数、转移灶最大直径是影响患者生存率的独立预后因素。结论淋巴结转移、术前化疗、肝转移病灶数、转移灶最大直径是影响患者远期生存的独立预后因素。

Objective To compare the long-term survival of colorectal cancer patients with liver metastases and its related influencing factors in one-stage surgical resection of colorectal liver metastasis.Methods 70 cases of colorectal cancer with liver metastasis in our hospital were retrospectively analyzed from January 2009 to December 2010. The regression analysis method combining with single and multiple factors were used to study the influence factors of the survival rate. Results All the patients in this group had no death in 30 days after operation. The median survival time was 46 months. The 1-year survival rate was 78. 57 %. 2-year survival rate was 55. 71 %. 3-year survival rate was 48. 57 %. 5-year survival rate was 42. 86 %. In all 70 patients,66 patients with liver metastases were operated for R0 removal,including 52 cases of wedge resection,13 case of half liver resection and 1 cases of extended resection.Complications were occurred in 9 cases（ 12. 86 %）. Lymph node metastasis,preoperative chemotherapy,liver metastasis number of lesions,liver metastasis of maximum diameter,levels of carcinoembryonic antigen and carbohydrate antigen 199 had significant relationship on the survival rate（ P〈0. 05）. Age,sex,location,tumor type,pathological type,liver metastatic distribution had no effect on the survival rate（ P〉0. 05）. Multivariate analysis showed that lymph node metastasis,preoperative chemotherapy,the number of liver metastasis,and the maximum diameter of the metastasis were independent prognostic factors of the survival rate. Conclusions Lymph node metastasis,preoperative chemotherapy,the number of liver metastasis,and the maximum diameter of the metastasis were independent prognostic factors of the survival rate of the colorectal cancer patients with liver metastasis.