结直肠癌肝转移的临床病理特征与术后生存关系分析

Correlation Between The Clinicopathological Features of Patients with Colorectal Liver Metastases and Their Postoperative Survival

目的通过分析结直肠癌肝转移临床病理学特征与术后生存因素的相互关系,寻找更多更准确的能够影响预后的指标对预后生存的影响,为结直肠癌肝转移患者的治疗策略提供参考。方法回顾性分析第二军医大学东方肝胆外科医院2006年1月至2009年12月期间收治并经手术治疗的233例结直肠癌肝转移患者的临床资料,采用Kaplan-Meier法计算生存率及生存曲线,并进行单因素分析,采用log-rank法进行统计学检验。将经单因素分析对预后有统计学意义的危险因素带入COX多因素回归模型,计算独立预后因素。结果本组患者术后中位生存期为37.0个月,术后1、3及5年累积生存率分别为93.0%、61.0%、17.0%。接受根治性手术患者的术后中位生存期、3及5年累积生存率优于姑息性手术者:40.53个月比27.20个月、59.0%比29.0%、20.0%比0(P<0.05)。对于总体生存期而言,单因素分析结果显示,手术方式、肝转移瘤切除术后首次复发时间、肝内转移灶数目、肝内转移灶最大直径、手术切缘、肝外不可切除转移灶及周围组织或器官侵犯、是否合并慢性肝病(慢性肝炎、脂肪肝、肝硬变)、术前血清CEA水平、CA19-9水平、是否为同时性肝转移、原发灶TNM分期、肝转移瘤生长位置和肝转移瘤包膜是否完整这13项是影响预后的因素(P<0.05);COX多因素分析结果显示,姑息性手术方式、同时性肝转移、肝转移瘤生长位置广泛、肝转移瘤无完整包膜、肝内转移灶多发、肝内转移灶最大直径>3 cm、存在肝外不可切除转移灶及周围组织或器官侵犯和未合并慢性肝病(慢性肝炎、脂肪肝、肝硬变)这8项因素是对结直肠癌肝转移患者术后生存产生影响的独立危险因素(P<0.05)。结论手术治疗可以使结直肠癌肝转移患者获得长期生存,姑息性手术方式、同时性肝转移、肝转移瘤生长位置广泛、肝转移瘤无完整包膜、肝内转移灶多发、肝内转移灶最大直径>3 cm,存在肝外不可切除转移灶及周围组织或器官侵犯、未合并慢性肝病(慢性肝炎、脂肪肝、肝硬变)等是影响结直肠癌肝转移患者术后预后的独立危险因素。

Objective By analyzing the correlation between the clinicopathological features of patients with colorectal liver metastases （CRLM） and their postoperative survival, this study is aimed to identify new and accurate prognostic indicators on the prognoses to provide a reference of the treatment strategy selection for patients with CRLM. Methods The clinical data of 233 patients with CRLM who received operation treatments in the Eastern Hepatobiliary Hospital of the Second Military Medical University from January 2006 to December 2009 were retrospectively investigated, and their clinicopathological features, as well as their prognosis were analyzed. The survival curve was drawn by Kaplan Meier method, and the survival rates were analyzed by log-rank test. Parametric survival analysis was used to identify predictors of cancer-specific survival. Results The median survival time after cancer resection was 37.0 months, with cumulative 1-year, 3-year, and 5-year survival rates of 93.0%, 61.0%, and 17.0%, respectively. The median survival time, with cumulative 3-year, and 5-year survival rates of patients who had received radical operations was better than the others who received palliative operations： 40.53 months vs 27.20 months, 59.0% vs 29.0%, and 20.0% vs 0 （P〈O.05）, respectively. In overall surviva, the results of univariate analysis showed that 13 factors, including surgical method, the first relapse after liver metastasis resection, the number of liver metastases, surgical margin, other unresectable extrahepatic metastases or resectable invasion in blood vessels or the surrounding tissue, whether any chronic liver disease was associ- ated, preoperative serum CEA level, preoperative serum CA19-9 leve, the position of the liver metastases, whether the liver metastasis capsule was complete, TNM stagethe of primary cancer, whether the liver metastasis was simultaneous liver metastases, and the maximum diameter of the liver metastases, were closely related to the dinicopathological features associated with prognosis and the differences were statistically significant （P〈0.05）. The results of multivariate survival analysis demonstrated that received palliative operations, simultaneous liver metastases, there were other unresectable extrahepatic metastases or resectable invasion in blood vessels or the surrounding tissue, liver metastases without a complete capsule, the number of liver metastases appeared as multiple and widedistribution, unassociated chronic liver disease of the patients, the maximum diameter of the liver metastases〉3 cm, were the independent risk factors affecting the postoperative survival of the patients with CRLM （P〈0.05）. Conclusions It is important for long-term survival of patients with CRLM who were received operations. Received palliative operations, simultaneous liver metastases, there were other unresectable extrahepatic metastases or resectable invasion in blood vessels or the surrounding tissue, liver metastases without a complete capsule, the number of liver metastases appeared as multiple and widedistribution, unassociated chronic liver disease of the patients, the maximum diameter of the liver metastases〉3 cm, were the independent risk factors affecting the postoperative survival of the nnti,~nte ,,Ti^h C＇~I ~x