大肠癌肝脏转移患者同期切除效果与相关因素研究

Study of outcomes and risk factors in patients undergoing simultaneous resection with colorectal liver metastases

目的探讨同期手术切除治疗大肠癌肝转移患者的疗效,并分析其相关影响因素。方法收集2007年3月-2009年12月西安交通大学医学部附属红会医院行同期切除治疗的86例同时性结直肠癌肝转移患者的临床资料,观察患者术后的近期及远期疗效,采用Logistic回归分析与预后相关的危险因素。结果 86例患者围手术期无死亡病例,术后5例患者出现切口感染,2例吻合口瘘,1例吻合口出血,3例发生胆漏。术后并发症发生率为12.79%(11/86),经腹腔引流和抗感染等对症支持治疗后获得治愈或明显缓解。至随访结束共42例患者死亡,中位生存时间为60个月,51例患者出现肿瘤复发或远处转移,其中肝内复发38例,肺内转移7例,其他部位转移者6例。患者1、3及5年总生存率分别为93.84%、75.58%及50.74%,无瘤生存率分别为88.37%、61.10%及31.80%。Logistic多因素回归模型结果显示:淋巴结转移阳性、肝脏转移灶数≥4个、肝切缘阳性及术前癌胚抗原水平≥100μg/L是影响患者预后的主要危险因素;术前新辅助化疗可以改善患者的预后。结论采用同期切除治疗大肠癌肝脏转移患者安全可行,淋巴结转移阳性、肝脏转移灶数≥4个、肝切缘阳性及术前癌胚抗原水平≥100μg/L是影响患者长期预后的主要因素,术前给予新辅助化疗对提高患者生存率有一定积极作用。

Objective To investigate the clinical effect of simultaneous resection in patients with colorectal liver metastases, and to analyze the related risk factors. Methods Clinical data of 86 patients underwent simultaneous resection with colorectal liver metastases, from March 2007 to December 2009 in our hospital were collected, and risk factors related to prognostic were analyzed by logistic regression analysis. Results No perioperative death was found in 86 patients. The postoperative complication rate was 12.79%（11/86）, including 5 patients with wound infection, 2 cases with anastomotic leakage, 1 case with anastomotic bleeding, 3 cases with bile leakage, which were cured or eased by drainage, antibiotics and other supportive treatments. Until the end of the follow-up, 42 patients died, and the median survival time was 60 months. A total of 51 cases had tumor recurrence or distant metastasis,including 38 cases had intrahepatic recurrence, 7 cases had lung metastasis and 6 cases had metastasis to other parts. The overall survival rates of 1-year, 3-year and 5-year were 93.84%, 75.58% and 50.74%, respectively, and the tumor-free survival rates were 88.37%, 61.10% and 31.80%. Logistic multivariate regression showed that lymph node metastasis, liver metastasis number ≥ 4 months, liver positive margin and preoperative carcinoembryonic antigen level ≥ 100 μg/L were major risk factors related to prognosis; neoadjuvant chemotherapy improved outcomes of patients. Conclusions Simultaneous resection of synchronous colorectal liver metastases is safe and feasible. Positive Lymph node metastasis, liver metastasis number ≥ 4 months, liver positive margin and preoperative carcinoembryonic antigen level ≥ 100 μg/L are the main risk factors of poor prognosis. Neoadjuvant chemotherapy can improve the survival rate of patients.