同时性结直肠癌肝转移患者同期手术的术前危险度评分体系初探

A Preliminary study on the preoperative risk score system for simultaneous operation for patients with colorectal cancer and liver metastases

目的建立同时性结直肠癌肝转移患者同期手术的术前危险度评分体系。方法收集上海长海医院2010年1月至2019年3月行同时性结直肠癌肝转移同期手术患者的临床病理资料,随访其复发和生存状况,统计分析不同临床病理指标的患者预后情况,采用单因素及多因素Cox回归分析影响患者预后的危险因素。以Cox分析中预后不良的危险因素为指标,每项危险因素计1分,按总分不同将患者分为不同组,分析每组中位生存时间、中位无病生存时间。结果共纳入234例患者,其中男性126例,女性108例,年龄(57.4±10.8)岁,中位生存期44.85个月,1年、3年、5年累积生存率分别为87.3%、55.2%、22.9%。其中原发肿瘤位于右半结肠、术前癌胚抗原≥200 ng/ml、多发肝转移瘤、低分化腺癌/粘液腺癌是患者预后不良的独立危险因素。以上4项每项各计1分,将患者分为低危(0~1分)组和高危(2~4分)组。低危组(n=174)和高危组(n=60)患者的中位生存时间分别为53个月和29个月,低危组和高危组患者的中位无病生存时间分别为21.34个月和8.48个月,差异均具有统计学意义(P<0.05)。结论依据本研究结果初步构建了针对结直肠癌同时性肝转移患者的愈后预测评分体系,以期对该类患者治疗方案的选择起到一定的指导作用。

Objective This study aims to analyze the prognosis of patients who underwent a simultaneous operations for colorectal cancer and liver metastases,and to establish a prognostic scoring system for these patients.Methods From January 2010 to March 2019,the clinicopathological data of patients with colorectal cancer and liver metastases simultaneously operated at Shanghai Changhai Hospital were collected.The clinicopathological prognostic factors on tumor recurrence and survival outcomes on follow-up were analyzed.Single and multiple factors Cox regression analyses were used to determine the risk factors which affected the prognosis of patients.Using the risk factors of poor prognosis on Cox analysis,1 point was given to each risk factor.Patients were then divided into different groups according to the different total scores.The median overall survival and disease-free survival of each group were analyzed.Results Of 234 patients included in this study,there were 126 males and 108 females.The average age was(57.4±10.8)years.The median survival was 44.85 months.The 1-,3-,and 5-year survival rates of the whole group were 87.3%,55.2%,and 22.9%,respectively.Primary tumor in right colon,preoperative carcinoembryonic antigen≥200 ng/ml,multiple liver metastases,and poorly differentiated adenocarcinoma/mucinous adenocarcinoma were independent risk factors of poor prognosis.After 1 point was given to each of the above 4 items,patients were then divided into the low-risk(0-1)and high-risk(2-4)groups.The median survivals of patients in the low-risk group(n=174)and high-risk group(n=60)were 53 months and 29 months,respectively.The corresponding median disease-free survivals were 21.34 months and 8.48 months,respectively.The differences between the 2 groups were significant(P<0.05).Conclusion The results of this study preliminary established a predictive scoring system for patients with simultaneous colorectal cancer and liver which can play a role in selecting treatment options for these patients.