6669例结直肠癌同时陛和异时性肝转移患者不同治疗策略的预后分析

目的 评价结直肠癌肝转移不同类型及治疗策略对肝转移患者生存的影响.方法 回顾分析复旦大学附属中山医院2000年1月1日至2008年6月31日收治的669例结直肠癌肝转移患者的病例资料.结果 本组患者同时性肝转移379例,异时性发生肝转移中位时间(21.0±19.6)个月]肝转移290例.患者性别、年龄和肠道原发病灶的部位两组差异无统计学意义(P>0.05);而肝转移灶特征(累及肝叶类型、病灶个数和病灶直径)和术前CEA、CA19-9水平两组差异有统计学意义(P<0.05).手术切除肝转移灶253例,其中同时性肝转移123例,异时性肝转移130例.以2008年10月31日为随访终点,随访率100%.同时性肝转移和异时性肝转移的中位生存时间分别为11和23个月(P<0.01).5年生存率分别为6.4%和11.4%(P<0.01):手术病例与各种非手术治疗(介入、化疗、射频、无水酒精注射和中医中药)病例的中位生存期分别为37个月和5～26个月(P<0.01);5年生存率分别为35.6%和0～3.6%(P<0.05).结论 手术治疗目前仍是结直肠癌肝转移的首选治疗措施;异时性肝转移患者生存率好于同时性肝转移.

Prognostic analysis of 669 liver metastasis of colorectal cancer cases REN Li, LV Shi-xu,

Objective To evaluate the relation between different therapy and survival rate of liver metastasis of eoloreetal cancer (LMCC). Methods Clinical data of 669 LMCC patients, collected from Fudan University Zliongshan Hospital from January 2000 to July 2008, were analyzed retrospectively.Results Of the 669 eases, 379 eases were synchronous liver metastases (SLM) and 290 cases were metachronous liver metastases (MLM). There were no significant differeneos in age, gender and position of primary tumor between SLM and MLM groups (P>0.05), but as to liver metastasis charaeteristics (liver lobe involved, focus number and maximal focus diameter) and CEA, CA19-9 before therapy,there were significant differences (P<0.05). Two hundred and fifty-three eases underwent curative hepatic resection, including 123 cases in SLM and 130 eases in MLM. Until October 31, 2008, all the cases were followedup. The median survival time of SLM was (11 ± 1) months and of MLM (23+2) months (P<0.01). Five-year survival rate of SLM was 6.4% and of MLM 11.4%(P<0.01). As to different treatments, median survival time and 5-year survival rate of curative hepatic resection group were 37months and 35.6%, and of non-operation groups (i.e. intervention, chemotherapy, radiofrequeney therapy and percutaneous ethanol injection) were 5 to 26 months and 0 to 3.6% respectively (P<0.05).Conclusions Curative hepatic resection is the first choice of liver metastasis of colorectal cancer,which can improve the survival rate. Resection rate and survival of MLM are better than those of SLM.