无法切除肝转移灶的结直肠癌患者初始切除原发肿瘤对预后的影响

Influence of Initial Primary Rumor Resection on Prognosis of Colorectal Cancer with Unresectable Liver Metastases

目的探讨无症状或症状轻微且无法切除肝转移灶的结直肠癌患者初始切除原发肿瘤对预后的影响,以及影响该类患者预后的相关因素。方法对徐州医科大学附属医院无法切除肝转移灶的结直肠癌患者的临床资料进行回顾性分析,根据初始是否行原发肿瘤切除分为手术组及非手术组。采用Kaplan-Meier法计算生存率,绘制生存曲线,组间差异采用Log-rank检验;通过COX回归分析影响预后的因素。结果80例患者中,手术组41例,非手术组39例,中位生存期及1年、3年累积生存率分别为22个月vs 21个月、82.9%vs 76.9%、28.0%vs 22.7%,差异无统计学意义(P>0.05)。单因素分析显示,原发肿瘤位置、有无肝外转移、是否联合贝伐单抗治疗、治疗前CEA水平、肝转移最大径、KRAS基因状态与预后显著相关(P<0.05);多因素分析结果显示,原发肿瘤位置、是否联合贝伐单抗治疗以及KRAS基因状态是影响生存的独立因素(P<0.05)。结论对于初诊无症状或症状轻微且肝转移灶无法切除的结直肠癌患者,与初始接受姑息化疗比较,初始接受原发肿瘤切除无明显生存优势,右半结肠癌、单纯化疗(未联合贝伐单抗)及KRAS基因突变是预后不良的独立因素。

Objective To investigate the effect of initial resection of primary tumors on the prognosis of patients with colorectal cancer with asymptomatic or mild symptoms and unresectable liver metastases,as well as the related factors affecting the prognosis of these patients.Methods The clinical data of patients with colorectal cancer and unresectable liver metastases in the Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed.According to the initial primary tumor resection,the patients were divided into the surgical group and the non-surgical group.The survival rate was calculated by Kaplan-Meier method,and the survival curve was drawn.The difference between groups was determined by Log-rank test.The factors affecting prognosis were analyzed by COX.Results Of the 80 patients,41 were in the surgical group and 39 in the non-surgical group.The median survival,1-year and 3-year cumulative survival rates were 22 months vs 21 months,82.9%vs 76.9%,28.0%vs 22.7%,respectively,the difference was not statistically significant(P>0.05).Univariate analysis showed that primary tumor location,extrahepatic metastases,combined with bevacizumab treatment,pre-treatment CEA levels,maximum hepatic metastases,and KRAS gene status were significantly associated with prognosis(P<0.05);multivariate analysis showed that primary tumor location,combined with bevacizumab treatment,and KRAS gene status were independent factors affecting survival(P<0.05).Conclusion For patients with colorectal cancer who had little to no symptoms and unresectable liver metastases,there was no significant survival advantage in the initial primary tumor resection compared with the initial palliative chemotherapy.Right-side colon cancer,chemotherapy alone(non-combined with bevacizumab)and KRAS gene mutations were independent risk factors for poor prognosis.