肝切除术局部治疗对结直肠肝脏寡转移患者预后及影响因素分析

Analysis of prognosis in patients with colorectal liver oligo-metastases undergoing liver resection and its predictive factors

目的比较肝切除手术与非手术治疗方式对于结直肠癌肝寡转移(CLOM)患者的治疗效果及影响预后因素。方法采用回顾性队列研究方法,对比分析2017-01-01-2020-06-01山东省肿瘤医院手术组(42例)和非手术组(62例)CLOM患者病例资料,包括年龄、性别、原发灶T分期、N分期、分化程度、转移时间、肝转移灶数、转移灶最大直径、肝转移诊断前化疗情况、血清癌胚抗原(CEA)和糖类抗原19-9(CA19-9)。根据RECIST1.1标准判定进展情况,影像学检查或PET-CT提示新发病灶或非手术治疗病灶增大判定为进展。结果手术组与非手术组总生存期分别为70.9(95%CI:59.3~82.5)和38.7(95%CI:33.8~43.6)个月,差异有统计学意义,χ^(2)=5.748,P=0.016。手术组和非手术组1年生存率分别为97.6%和90.3%,差异有统计学意义,χ^(2)=1.624,P=0.012;3年生存率分别为75.5%和60.7%,差异有统计学意义,χ^(2)=11.134,P=0.007。Cox回归显示,女性患者死亡风险高于男性(HR=2.505,95%CI:1.191~5.269,P=0.015),原发灶N_(1)及N_(2)期患者较N_(0)期患者生存期更短(HR=3.000,95%CI:1.125~8.003,P=0.028)。未行肝切除手术患者的死亡风险是手术患者的4倍(HR=4.008,95%CI:1.597~10.059,P=0.003)。结论相较于非手术治疗方法,肝切除手术能够延长CLOM患者生存时间。此外,性别和原发灶N分期是CLOM患者的独立预后因素。

Objective To compare the effectiveness of liver resection and non-surgical treatments in patients with colorectal liver oligo-metastases(CLOM)and analyze the prognostic factors.Methods A retrospective cohort study was used to compare and analyze the clinicopathological data of CLOM patients in the surgical group(42 cases)and non-surgical group(62 cases)in Shandong Cancer Hospital from January 1,2017 to June 1,2020.Age,gender,primary tumor location,T stage,N stage,degree of differentiation,number of liver metastases,maximum diameter of metastases,chemotherapy before diagnosis of liver metastases,fibrinogen carcinoembryonic antigen(CEA),and carbohydrate antigen 19-9(CA19-9)were included.According to RECIST 1.1 criteria,a new lesion or an enlarged non-surgically treated lesion indicated by imaging or PET-CT was defined as progression.Results The overall survival(OS)of the surgical group and the non-surgical group were 70.9 months(95%CI:59.3-82.5)and 38.7 months,respectively(95%CI:33.8-43.6)with significant difference between the two groups(χ^(2)=5.748,P=0.016).The survival rates of the surgical group and the non-surgical group at 1 and 3 years were 97.6%,75.5%and 90.3%,60.7%,respectively,which was statistically significant(χ^(2)were 1.624 and 11.134,P were 0.012 and 0.007).The multivariate analysis suggested that the females had a significantly higher risk of death than that of the males(HR=2.505,95%CI:1.191-5.269,P=0.015),advanced N stage was associated with poor prognosis(HR=3.000,95%CI:1.125-8.003,P=0.028).Patients without liver resection had 4 times of mortality risk than those with surgery(HR=4.008,95%CI:1.597-10.059,P=0.003).Conclusions Current study showed that liver resection significantly improved patients’survival compared with non-surgical treatments.Moreover,liver resection,gender,and N stage of the primary tumor were independent prognostic factors for patients with CLOM.