Ⅳ期直肠癌患者原发肿瘤的外科治疗

Surgical therapy for patients with stage Ⅳ primary rectal cancer

目的探讨针对Ⅳ期直肠癌原发瘤手术治疗的价值及适应证。方法回顾性分析5 3例Ⅳ期直肠癌原发瘤手术切除病例的临床资料。结果 5 3例患者一般状况按美国东部肿瘤协作组评分标准均为 1分 ,17例 (32 % )患者仅行手术治疗 ,36例患者接受辅助放化疗治疗。中位随访时间 14个月 ,4 7例患者术后 1年内肿瘤相关症状得到缓解 ;中位生存时间为 16个月 ,2年总生存率为2 4 % ;多因素分析术后化疗与生存相关 (P =0 0 4 6 )。结论Ⅳ期直肠癌原发肿瘤手术切除可提高患者的生活质量 ,对于全身状况良好、转移负荷较小及肝脏无明显受损患者 ,应争取手术切除并给予有效的化学治疗。

Objective To explore the value and criteria for primary tumor resection in patients with stage Ⅳ rectal cancer. Methods The clinical data were retrospectively analyzed for 53 patients with stage Ⅳ rectal cancer undergoing primary tumor resection. Results All patients were graded according to Eastern Cooperative Oncology Group (ECOG) performance as status 1. Seventeen of 53 patients (32%) received palliative resection. Thirty-six patients received adjuvant radiotherapy and/or chemotherapy. The median follow-up was 14 months. Forty-seven patients had complete resolution of their symptoms related to the primary rectal cancer for a year. The median survival was 16 months and 2-year overall survival of 24.5%. On multivariate analysis, chemotherapy was a determinant of prolonged survival (P=0.046). Conclusions Resection of primary tumor in patients with stage Ⅳ rectal cancer can improve the quality of life. Patients who have a good performance status, minimal metastatic disease and normal preoperative liver function tests should undergo resective surgery and aggresive systemic chemotherapy.