临床危险评分系统对结直肠癌肝转移患者生存预测及指导新辅助化疗的意义研究

Value of clinical risk score in predicting survival and guiding neoadjuvant chemotherapy in patients with colorectal cancer with liver metastasis

目的评估临床危险评分系统(CRS)对我国结直肠癌肝转移患者的生存预测及指导新辅助化疗决策的作用。方法回顾性分析2000年1月至2012年12月在中山大学肿瘤医院行手术治疗的145例结直肠癌肝转移患者的临床资料,并随访其复发和生存情况,比较CRS低危组和高危组患者的预后差异并分析CRS评分对患者新辅助化疗的影响。结果低危组和高危组患者的中位总生存时间分别为47.5(32,75)个月和21(12,38)个月,差异有统计学意义(P <0.05);低危组和高危组患者的无复发中位生存时间分别为32(9,67)个月和11(7,18)个月,差异有统计学意义(P <0.05)。低危组中接受新辅助化疗和直接手术患者的中位总生存时间分别为42(26,64)个月和55(32,78)个月,差异无统计学意义(P> 0.05);无复发中位生存时间分别为11(7,56)个月和45(13,73)个月,差异有统计学意义(P <0.05)。高危组中接受新辅助化疗和直接手术患者的中位总生存时间分别为33.5(12,48)个月和17(13,26)个月,差异无统计学意义(P> 0.05);无复发中位生存时间分别为10(6,22)个月和12(7,16)个月,差异无统计学意义(P> 0.05)。结论 CRS对结直肠癌肝转移患者的生存情况有较好的预测作用,但是否能作为此类患者实施新辅助化疗的参考依据还需要进一步的研究。

Objectives To investigate the effect of clinical risk score(CRS)in predicting survival and guiding neoadjuvant chemotherapy in patients with colorectal cancer with liver metastasis in China.Methods This was a retrospective analysis of clinical data of 145 patients with colorectal cancer with liver metastasis surgically treated in Sun Yat-sen University Cancer Center between January 2000 and December 2012.We followed-up the patients to record recurrence and survival.Prognosis was compared between patients with low and high risk and the effect of CRS on patients’neoadjuvant chemotherapy was analyzed.Results Median survival time was 47.5(32,75)months and 21(12,38)months for patients with low and high risk,respectively,and there was significant between-group difference(P<0.05).Median recurrence-free survival time was 32(9,67)and 11(7,18)months for patients with low and high risk,respectively,and there was significant between-group difference(P<0.05).In patients with low risk,median overall survival time was 42(26,64)months and 55(32,78)months for patients received neoadjuvant chemotherapy and those received surgery directly,respectively,and there was no between-group difference(P>0.05).The corresponding figures for median recurrence-free survival time was 11(7,56)months and 45(13,73)months,respectively,with significant between-group difference(P<0.05).In patients with high risk,median overall survival time was 33.5(12,48)months and 17(13,26)months for patients received neoadjuvant chemotherapy and those received surgery directly,respectively,and there was no between-group difference(P>0.05).The corresponding figures for median recurrence-free survival time was 10(6,22)months and 12(7,16)months,respectively,with no significant between-group difference(P>0.05).Conclusion CRS can predict prognosis in patients with colorectal cancer with liver metastasis.Whether it can be used to guide neoadjuvant chemotherapy in these patients requires further studies.