影响结直肠癌肝转移手术切除患者预后的多因素分析

目的 探讨影响结直肠癌肝转移患者手术切除的预后因素。方法 收集1995-2001年间收治的结直肠癌肝转移手术切除患者103例的资料，用Kaplan-Meier法计算术后生存率，以Cox模型进行多变量分析。结果 患者术后1、3年无瘤生存率分别为73．8％和43．7％，术后1、3年累积生存率分别为7g．6％和49．5％。单因素分析显示：术前血清CEA水平、转移灶与原发灶的治疗间隔时间、术中切缘情况、肝门淋巴结转移、肝内卫星灶的存在与否、肝转移灶的最大直径、数目及有无包膜影响患者的术后肝内复发和术后累积生存率，而术后化疗可以提高患者的累积生存率。多因素分析显示：转移灶与原发灶的治疗间隔时间、切缘情况、肝内卫星灶的存在与否和肝转移灶的最大直径是影响肝内复发和累积生存率的独立因素，而肝门淋巴结转移是影响累积生存率的独立因素，有无包膜是影响肝内复发的独立因素。结论 手术切除是结直肠癌肝转移有效的治疗手段。转移灶与原发灶的治疗间隔时间、切缘情况、肝内卫星灶、肝转移灶的大小和包膜、肝门淋巴结转移等是患者预后的独立影响因素。

Prognostic factors of colorectal cancer patients undergoing hepatectomy for liver metastases

Objective To evaluate prognostic factors in colorectal cancer patients undergoing hepatectomy for liver metastases. Methods This study included 103 colorectal cancer patients with hepatic metastases undergoing hepatectomy with curative intent between January 1995 and December 2001. Data were analyzed by Kaplan-Meier method, Log-rank test and Cox regression. Results The 1- and 3-year intrahepatic recurrence free rates were 73.8% and 43.7% respectively. The 1- and 3-year overall survival rates were 78.6% and 49.5% respectively. With univariate analysis, preoperative serum CEA level, pathological type of primary tumor, the interval between surgery for colorectal cancer and that for liver metastasis, hepatic tumor resection margin, hilar lymph node metastases, intrahepatic satellite metastases, tumor size, and number, the presence of metastatic tumour's envelope were found to be significant factors associating with intrahepatic recurrence and overall survival. Postoperative chemotherapy was associated with overall survival. With multivariate analysis, the interval time, tumor resection margin, satellite metastases and size independently affected both intrahepatic recurrence and overall survival. Lymph node metastases independently affected overall survival. Metastatic tumour's envelope independently affected intrahepatic recurrence. Conclusions The interval between the surgery of colorectal cancer and that of hepatic tumours, hepatic tumor margin, and satellite metastases, tumor size, lymph node metastases and metastatic tumour's envelope are independent factors predicting patients' prognosis.