结直肠癌肝转移患者生存状况及预后影响因素分析

Analysis of survival status and prognostic factors in patients with colorectal cancer with liver metastasis

目的综合分析结直肠癌肝转移患者的生存状况及预后影响因素。方法回顾性分析2019年1-6月重庆大学附属中心医院收治84例结直肠癌肝转移患者的临床及随访资料。收集患者的基本情况,采用Kaplan-Meier方法计算中位生存时间,采用Log-rank检验进行单因素分析,采用Cox回归模型分析结直肠癌肝转移患者预后的相关影响因素。结果84例结直肠癌肝转移患者全部完成随访,中位随访时间25.5个月,随访率为100.0%,未出现失访。1、2、3年生存率分别为84.52%(71/84)、66.67%(56/84)、51.19%(43/84),中位生存时间为(25.16±5.48)个月。单因素分析结果显示,近6个月体重是否下降超20%与预后有关(P<0.05);MRI直肠壁外血管侵犯评分(mrEMVI)、病理类型、病理分级、mrT分期、mrN分期、环周切缘(CRM)、浸润长度、浸润深度、肿瘤下端距离肛缘以及肝转移病灶数的组间差异显著,与预后有关(P<0.05);新辅助化疗、手术时间和并发症的组间差异显著,与预后有关(P<0.05)。各因素对患者预后影响从高到低依次为:近6个月体重下降超20%(OR=2.264)、肝转移病灶数(OR=2.035)、病理类型(OR=1.751)、新辅助化疗(OR=1.382)、病理分级(OR=1.186)。结论近6个月体重下降超20%、mrEMVI、病理类型、病理分级、mrT分期、mrN分期、CRM、浸润长度、浸润深度、肿瘤下端距离肛缘、肝转移病灶数、新辅助化疗、手术时间以及并发症是影响结直肠癌肝转移患者预后的主要因素,临床可针对上述因素,在术前和术后采取及时有效的预防措施,可使患者生存获益,改善患者预后。

Objective To comprehensively analyze the survival status and prognostic factors of colorectal cancer patients with liver metastasis.Methods The clinical and follow-up data of 84 patients with liver metastasis from colorectal cancer in the Central Hospital Affiliated to Chongqing University from January to June 2019 were analyzed retrospectively.The basic information of patients was collected,Kaplan-Meier method was used to calculate the median survival time,Log-rank test was used for univariate analysis,and Cox regression model was used to analyze the related factors affecting the prognosis of colorectal cancer patients with liver metastasis.Results All 84 patients with liver metastasis from colorectal cancer were followed up,the median follow-up time was 25.5 months,the follow-up rate was 100.0%,and there was no loss of follow-up.The 1-year,2-year and 3-year survival rates were 84.52%(71/84),66.67%(56/84)and 51.19%(43/84),respectively.The median survival time was(25.16±5.48)months.The results of univariate analysis showed that whether the body weight decreased more than 20%in recent 6 months was related to the prognosis(P<0.05).There were statistically significant differences between groups in mrEMVI,pathological type,pathological grade,mrT stage,mrN stage,circumferential resection margin(CRM),invasion length,invasion depth,the distance from the lower end of the tumor to the anal margin,and the number of liver metastatic lesions,which were related to the prognosis(P<0.05).There were statistically significant differences in neoadjuvant chemotherapy,operation time and complications between groups,which were related to the prognosis(P<0.05).The influence of each factor on the prognosis of patients from high to low were:weight loss of more than 20%in recent 6 months(OR=2.264),number of liver metastases(OR=2.035),pathological type(OR=1.751),neoadjuvant chemotherapy(OR=1.382),pathological classification(OR=1.186).Conclusion Over 20%weight loss,mrEMVI,pathological type,pathological grade,mrT stage,mrN stage,CRM,length of invasion,depth of invasion,distance from the lower end of the tumor to the anal margin,number of liver metastatic lesions,neoadjuvant chemotherapy,operation time and complications are the main factors affecting the prognosis of patients with colorectal cancer with liver transfer.Clinically,timely and effective preventive measures can be taken before and after the operation to benefit the survival of patients and improve the prognosis of patients.