术前肝动脉联合区域动脉灌注化疗预防结直肠癌术后肝转移

目的探讨术前肝动脉联合区域动脉灌注化疗(PHRAIC)预防结直肠癌根治术后肝转移的作用。方法将222例结直肠癌患者随机分成PHRAIC组(110例)和对照组(112例),两组性别、年龄、肿瘤部位、肿瘤大小、分期、肿瘤分化程度、术后化疗和随访时间等差异无统计学意义。PHRAIC组术前7d予以肝动脉联合区域动脉灌注化疗氟脱氧尿苷(FUDR)+丝裂霉素(MMC)+奥沙利铂],对照组则直接接受手术治疗,两组术后均常规接受全身静脉化疗。随访术后3年的肝转移率、无瘤生存率和总生存率以及中位生存期。结果PHRAIC组和对照组的术后并发症差异无统计学意义。Ⅲ期结直肠癌PHRAIC组和对照组的3年肝转移率、3年无瘤生存率、总生存率和中位生存期分别为12.7%和28.3%(P=0.01)、82.3%和58.7%(P<0.05)、87.7%和75.7%(P<0.05)以及40个月±5个月和36个月±3个月(P=0.03);对于Ⅲ期结直肠患者,术前采用PHRAIC可降低术后肝转移的风险55%、术后转移复发风险57%。对于Ⅱ期患者,术前PHRAIC作用不明显。结论术前肝动脉联合区域动脉灌注化疗安全、有效,可显著降低Ⅲ期结直肠癌术后肝转移发生率,延长患者生存期。

Preoperative hepatic and regional arterial infusion chemotherapy in the prevention of liver metastasis after colorectal cancer surgery

OBJECTIVE: To investigate the effects of preoperative hepatic and regional arterial infusion chemotherapy (PHRAIC) in the prevention of liver metastasis of colorectal cancer after surgery. METHODS: 110 patients of colorectal cancer underwent perfusion of 3 anti-tumor drugs into the hepatic artery and nutrient artery of the tumor respectively, radical surgery of the colorectal cancer 7 days after, and then general venous chemotherapy 3 weeks after operation, 112 patients underwent radical surgery of the colorectal cancer and general venous chemotherapy 3 weeks after operation. Follow-up was carried out every month with a follow-up period of 34 months +/- 3 months. RESULTS: There were no significant difference in post-operational complications between these 2 groups. The 3-year liver metastasis rate, 3-year tumor-free survival rate, overall survival rate, and median survival time of the stage III patients in the PHRAIC group were 12.7%, 82.3%, 87.7%, and 40 months +/- 5 months, all significantly better than those in the control group (28.3%, 58.7%, 75.5%, and 36 months +/- 3 months respectively, P < 0.05 or P < 0.01). CONCLUSION: PHRAIC reduces the liver metastasis of colorectal cancer after radical surgery and improves the survival of the stage III patients.