不同部位结直肠癌伴同时性肝转移患者的临床病理特征及预后分析

Clinicopathological characteristics and prognosis of patients with synchronous liver metastases from colorectal cancer of different primary sites

目的探讨不同部位结直肠癌伴同时性肝转移患者的临床病理特征及预后情况。方法对111例结直肠癌伴同时性肝转移患者的临床资料进行分析,比较左半结肠癌、右半结肠癌和直肠癌伴同时性肝转移患者的临床病理特征,并分析影响预后的因素。结果不同部位结直肠癌伴同时性肝转移患者在贫血、肠梗阻、原发灶大体病理类型、肝转移灶最大径方面比较,差异均有统计学意义(均P<0.05),其中右半结肠癌伴同时性肝转移患者更易合并贫血,肝转移灶相对较大;在原发灶大体病理类型上各有特点,左半结肠癌伴同时性肝转移以浸润型为主,右半结肠癌伴同时性肝转移以隆起型为主,直肠癌伴同时性肝转移以溃疡型为主;在肠梗阻发生率上,结肠癌伴同时性肝转移患者高于直肠癌伴同时性肝转移患者(均P<0.05),而左、右半结肠癌伴同时性肝转移患者比较差异无统计学意义(P>0.05)。89例随访资料完整的患者中,死亡52例,存活37例;总生存期(OS)为1~72个月,生存期为19(10,42)个月,5年总生存率为2.2%;不同部位结直肠癌伴同时性肝转移患者生存率比较,差异无统计学意义(P>0.05)。经Cox比例风险模型分析,治疗方式是结直肠癌伴同时性肝转移预后的独立影响因素(P<0.05)。结论不同部位结直肠癌伴同时性肝转移患者各有其临床病理特点;治疗方式影响结直肠癌伴同时性肝转移患者的预后,以手术为主的综合治疗有利于改善肝转移患者的预后。

Objective To examine the clinicopathological characteristics and prognosis of patients with synchronous liver metastases from colorectal cancer of different primary tumor sites.Methods Clinicopathological data of 111 patients with synchronous liver metastases from colorectal cancer were retrospectively reviewed.The clinicopathological characteristics and prognosis of patients with colorectal cancer of different primary tumor sites were compared.Results Patients with right-sided colon cancer was associated with a higher rate of anemia(P<0.05)and bigger liver metastases(P<0.05).The pathologic types of primary tumor were significantly different among left-sided colon cancer,right-sided colon cancer and rectal cancer(P<0.05).Colon cancer with synchronous liver metastases was associated with a higher rate of bowel obstruction than rectal cancer(P<0.05),while there was no difference between right-sided and left-sided colon cancer(P>0.05).The median overall survival was 19(10,42)months and the 5-year overall survival was 2.2%in this series.There was no significant difference in survival among patients with different sites of colorectal cancers.Multivariate Cox regression analysis showed that therapeutic method was the independent prognostic factor of patients.Conclusion The clinicopathological characteristics of colorectal cancer with synchronous liver metastases are different according to the location of primary tumor.Therapy method is an independent prognosis factor for colorectal cancer patients with synchronous liver metastasis.