散发性青年直肠癌肝转移患者临床特点及其预后影响因素

Clinical characteristics and prognostic factors of young patients with sporadic rectal cancer liver metastasis

目的探讨散发性青年直肠癌肝转移(RCLM)患者的临床特点及其预后影响因素。方法回顾性分析2016年1月-2021年1月北京大学第一医院收治的青年RCLM患者(发病年龄≤45岁)的临床病理资料(设为青年组,n=40),并按照1∶2的比例纳入中老年RCLM患者(发病年龄>45岁,设为中老年组,n=82)。比较两组临床病理因素的差异性,采用单因素及多因素Cox回归分析影响RCLM及青年RCLM患者预后的危险因素,结合Kaplan-Meier生存曲线分析肝转移瘤直径与局部治疗之间的预后关系。结果共纳入RCLM患者122例,青年组1、3、5年生存率分别为97.5%、47.5%、15.0%,中老年组1、3、5生存率分别为84.1%、26.8%、9.8%。两组BMI(P=0.008)、原发肿瘤存在并发症情况(P=0.006)、肝转移发生时限中同时性肝转移(P=0.005)、肝转移瘤最大直径>3 cm(P=0.019)差异有统计学意义。单因素及多因素Cox回归分析显示,年龄(P=0.003)、原发肿瘤N分期(P=0.007)、肝转移瘤局部治疗(P=0.047)和肝转移瘤最大直径(P=0.030)是影响RCLM患者预后的独立危险因素,原发肿瘤是否根治性切除(P=0.035)和肝转移瘤最大直径(P=0.041)是影响青年RCLM患者预后的独立危险因素。肝转移瘤最大直径与肝转移瘤局部治疗组间生存期差异有统计学意义(log-rank P=0.000)。结论青年RCLM患者肿瘤初始分期较晚,但生存预后优于中老年RCLM患者。淋巴结转移程度高、肝转移瘤未经局部治疗以及肝转移瘤最大直径>3 cm提示RCLM患者预后不良。原发肿瘤根治性切除及肝转移瘤最大直径是影响青年RCLM患者预后的独立危险因素,肝转移瘤局部治疗在RLCM患者治疗策略中起重要作用。

Objective To identify the clinical characteristics and prognostic factors of young patients with sporadic rectal cancer liver metastasis(RCLM).Methods The clinical data of young RCLM patients at 45 years or under(n=40,as younger patient group)in Peking University First Hospital from January 2016 to January 2021 were reviewed,meanwhile,elder RCLM patient group were comprised of 82 patients older than 45-year-old in a 1:2 ratio.Proportions of categorical variables were compared between young patients and old patients.The clinicopathologic parameters were analyzed with univariate and multivariate Cox regression models and Kaplan-Meier method for demonstrating survival differences between the maximum diameter of liver metastasis and local therapy.Results One hundred and twenty-two RCLM patients were identified,the 1-,3-and 5-year survival rates of young patient group were 97.5%,47.5%,15.0%,those of elder patient group were 84.1%,26.8%,9.8%,respectively.The differences in BMI(P=0.008),primary tumor with obstruction and bleeding(P=0.006),synchronous rectal cancer liver metastases(P=0.005),the maximum diameter of liver metastasis>3 cm(P=0.019)were statistically significant between the two groups.And univariate and multivariate analyses showed that age(P=0.003),N stage(P=0.007),local therapy for liver metastases(P=0.047)and the maximum diameter of liver metastasis(P=0.030)were independent risk factors for influencing the prognosis of RCLM patients;curative resection or not of primary tumor(P=0.035)and the maximum diameter of liver metastasis(P=0.041)were independent risk factors for influencing the prognosis of young RCLM patients.Kaplan-Maier curve demonstrated survival differences between the maximum diameter of liver metastasis and local therapy for liver metastasis in RCLM patients(log-rank P=0.000).Conclusions Although with later staging of initial tumor station,young RCLM patients may obtain better survival benefit compared with old patients.Higher degree of lymph node metastasis,local therapy for liver metastases and the maximum diameter of liver metastasis>3 cm indicates poor prognosis in RCLM patients,and without curative resection of primary tumor and maximum diameter of liver metastasis are also considered as the independent poor prognostic factors of young RCLM patients.Local therapy for liver metastases appears to play an important role in the treatment strategy of RCLM patients.