影响大肠癌肝转移患者预后因素分析

[目的]分析大肠癌肝转移手术治疗的疗效和影响因素.[方法]随访36例大肠癌肝转移术后患者,以寿命表法求总生存率.采用Kanplan-Meier法进行单因素分析,采用比例风险模型(COX模型)进行多因素分析.[结果]36例患者1年生存率100%,3年生存率36.1%,5年生存率8.3%.多因素分析显示Duke's分期、组织学分型、区域淋巴结转移和手术方式是影响大肠癌肝转移患者预后的因素(P＜0.05).[结论]大肠癌肝转移的治疗手段要争取根治性手术方式,早发现、早治疗可提高长期生存期.     

大肠癌肝转移的生存与其相关因素之间的关系

探讨大肠癌肝转移病人的生存与相关因素之间的关系。我们对５０例大肠癌肝转移病人的临床因素，生存质量、肿瘤大小、血清碱性磷酸酶和体重进行评估。体质症状评分是一个较ＣＴ扫描测量肿瘤大小更精确的生存预告者，预测生存的最好模型包括腹泻、进食、何处工作能力和睡眠等生活质量问题。唯一临床测量变量是血清碱性磷酸酶水平，研究展示生活质量能预测大肠癌杆转移的生存。肿瘤产物和肿瘤大小和差异能影响病人的健康和大肠癌的生存     

大肠癌肝转移的诊治进展

结直肠癌是我国常见的恶性肿瘤之一,发病率逐年增高,是我国第四大常见肿瘤,在上海市区已经成为第二大常见肿瘤。大约40%的结直肠癌患者最终死于肿瘤转移,肝脏是最主要的转移部位。大约有15%~25%的患者在确诊大肠癌时即伴有肝转移,还有25%~50%的患者在肠癌术后3年内发生肝转移[1     

77例直肠癌伴肝转移患者的预后因素分析

目的 探讨影响直肠癌伴肝转移患者预后的相关因素.方法 回顾性分析77例直肠癌伴肝转移患者的临床病理资料,以Kaplan-Meier法分析患者的总生存率,以Log rank检验和Cox模型对影响患者生存的临床病理因素进行单因素和多因素分析.结果 全组患者的中位生存时间为12个月,1、2、3和5年生存率分别为47.7%、28.0%、13.1%和1.5%.单因素分析结果显示,原发肿瘤的分化程度越低、肠壁浸润程度越深、有淋巴结转移、肝转移灶分布于双叶、肝转移灶数目＞1个、肝转移灶的最大直径＞5 cm、有肝外受侵或转移、确诊时癌胚抗原(CEA)≥5 ng/ml以及未行根治性手术者的预后较差(均P＜0.05).多因素分析结果显示,原发肿瘤的分化程度(P=0.007)、肠壁浸润深度(P=0.027)、肝转移灶的最大直径(P=0.003)以及确诊时的CEA水平(P=0.000)为影响直肠癌伴肝转移患者预后的独立因素.结论 对于直肠癌伴肝转移的患者,原发肿瘤的分化程度越高、肠壁浸润越浅、肝转移灶的最大直径越小以及确诊时CEA水平越低,患者的预后越好.     

大肠癌肝转移的外科治疗

肝脏是大肠癌最常见的远处转移器官,正确地处理肝转移是提高大肠癌总体疗效的主要措施之一.手术切除为治疗肝转移的首选,合理的临床分期有助于疗效的评估,随着相关技术的发展、并发症的减少,手术指征被逐步放宽,对手术时机掌握的认识也在发生着变化,某些基因及其表达产物可用于评估疗效或预后;肝转移不能切除的病人疗效虽差,但积极的肝动脉结扎或栓塞并配合区域化疗或放疗及其它综合治疗措施,仍能有效延长病人的生存期.     

大肠癌预后的多因素分析

影响大肠癌预后的因素很多 ,大肠癌患者生存期是多种因素共同影响的结果。本文采用多因素Ｃｏｘ模型对我院收治的２４２例大肠癌进行多因素综合分析 ,以探讨影响大肠癌生存期的主要因素。１资料与方法１ １临床资料我院１９８８年～１９９４年收治了３７６例大肠癌病例 ,通过对所有病例进行整理、核实 ,得到有效病例２４２例。对２４２例进行随访 ,以确定其生存期 ,调查截止日期为１９９９年６月３０日。所有病例均经病理诊断 ,随访率为９３ ４%。其中男性１５８例 ,女性８４例 ,结肠癌８３例 ,直肠癌１５９例。１ ２方法本组病例所分析的预…     

大肠癌肝转移的导管灌注治疗

大肠癌肝转移的导管灌注治疗刘宝善四川省肿瘤医院外科（６１００４１）大肠癌是常见的恶性肿瘤。欧美国家年发病率约为２５～３５／１０万，占恶注肿瘤的１～２位；我国年发病率为９～１２／１０万，每年有十几万人罹患此病。近年随着经济的发展，生活水平的提高，大肠癌...     

胃癌肝转移患者预后影响因素分析

摘 要：［目的］ 探讨影响胃癌肝转移患者的预后因素。［方法］ 回顾性分析收治的82例胃癌肝转移患者的临床病理资料,对患者的生存时间进行随访,计算患者的1、2年生存率,及中位生存时间（median survival time,MST）。采用Log-rank检验及Cox比例风险模型对可能影响胃癌肝转移患者生存的影响因素进行单因素及多因素分析。［结果］ 82例胃癌肝转移患者1、2年生存率分别为46.3%、13.4%,MST为10.9个月。单因素分析结果显示,病理类型、分化程度、肝转移灶数目、化疗、介入治疗、甲胎蛋白（α-fetoprotein,AFP）与胃癌肝转移患者的预后相关;多因素分析结果显示,病理类型（HR=0.470,95%CI：0.256～0.861,P=0.015）、肝转移灶数目（HR=0.413,95%CI：0.233～0.732,P=0.002）是影响胃癌肝转移患者预后的独立危险因素,化疗（HR=2.193,95%CI：1.354～3.551,P=0.001）是胃癌肝转移患者的独立保护因素。［结论］胃癌肝转移患者预后较差,尤其是病理恶性程度较高及肝转移数目较多的患者,化疗可改善患者的预后。     

结直肠癌肝转移患者预后因素分析

目的 :探讨结直肠癌肝转移患者外科治疗后的预后影响因素及临床意义。 方法 :分析本院1995年1月至2000年12月158例经病理证实、随诊资料完整的结直肠癌肝转移病例临床资料,对影响患者生存的12项因素进行单因素、多因素分析。 结果 :根治性切除67例(42.4%)、姑息性切除53例(33.5%)、探查术或最佳支持治疗38例(24.1%);术后化疗82例(51.9%)、术后未化疗76例(48.1%);切缘阴性132例(83.5%)、切缘阳性26例(16.5%);中位生存期41个月,5年生存率27.0%。单因素分析表明,外科治疗方式(P=0.013<0.05)、原发瘤N分期(P=0.003<0.05)、转移灶大小(P=0.037<0.05)及分布(P=0.032<0.05)和切缘(P=0.000<0.001)、辅助性治疗(P=0.041<0.05)为预后影响因素;多因素回归分析显示,仅有原发瘤N分期(P=0.004<0.05)为预后的独立影响因素,淋巴结转移的相对危险度为2.086。 结论 :结直肠癌肝转移的根治性切除是患者获得长期生存的有效治疗手段:对于结直肠癌肝转移患者应恰当选择病例,力求一期根治性切除;不适合一期根治性切除者,应采用新辅助化疗手段,降级肿瘤的临床病理分期,以期提高根治性切除率,提高患者生存期。     

Prognostic factors for patients with liver metastases from breast cancer

Summary Background The prognosis of patients with liver metastases from breast cancer is commonly poor. After initial diagnosis of hepatic metastases, a median survival time of 1–20 months can be expected. The definition of prognostic factors for such patients may influence therapeutic decisions. In particular, the characterization of patients who can expect long-term survival could assist in optimizing treatment. Methods We retrospectively studied n=350 patients with liver metastases from breast cancer. All patients were stratified following their survival after occurrence of liver metastases. Kaplan–Meier studies were performed, as well as univariate and multivariate analyses of several clinical, histopathological and therapeutic factors. Results Median survival time was 14 months. N=66 (18.9%) patients survived longer than 36 months after the primary diagnosis. Multivariate analysis showed prognostic relevance for the time interval between the primary diagnosis of breast cancer and the initial diagnosis of hepatic metastases (p<0.05). Furthermore, prognostic relevance was found for the pattern of metastasization (p<0.05) and for signs of hepatic dysfunction (ascites, jaundice, p<0.005). Univariate analysis showed a prognostic benefit for patients with an expression of Ki-67<20%, p53<50% and a positive hormonal receptor status. Patients who received a regional therapy survived on average longer than patients who were only treated systemically (33 versus 11 months, p<0.001). Conclusions Consideration of prognostic implications of the described parameters may help to find the most appropriate treatment for patients with liver metastases from breast cancer. The possibility of local therapeutic interventions should be considered in a defined subgroup.     

Prognostic factors for patients with hepatic metastases from breast cancer

Median survival from liver metastases secondary to breast cancer is only a few months, with very rare 5-year survival. This study reviewed 145 patients with liver metastases from breast cancer to determine factors that may influence survival. Data were analysed using Kaplan-Meier survival curves, univariate and multivariate analysis. Median survival was 4.23 months (range 0.16-51), with a 27.6% 1-year survival. Factors that significantly predicted a poor prognosis on univariate analysis included symptomatic liver disease, deranged liver function tests, the presence of ascites, histological grade 3 disease at primary presentation, advanced age, oestrogen receptor (ER) negative tumours, carcinoembryonic antigen of over 1000 ng ml(-1) and multiple vs single liver metastases. Response to treatment was also a significant predictor of survival with patients responding to chemo- or endocrine therapy surviving for a median of 13 and 13.9 months, respectively. Multivariate analysis of pretreatment variables identified a low albumin, advanced age and ER negativity as independent predictors of poor survival. The time interval between primary and metastatic disease, metastases at extrahepatic sites, histological subtype and nodal stage at primary presentation did not predict prognosis. Awareness of the prognostic implications of the above factors may assist in selecting the most appropriate treatment for these patients.British Journal of Cancer (2003) 89, 284-290. doi:10.1038/sj.bjc.6601038 www.bjcancer.com     

Optimal management of pulmonary metastases from colorectal cancer

The incidence of colorectal cancers is rising worldwide and pulmonary metastases were seen in approximately 10–15% of all patients. Surgical metastasectomy is a widely accepted procedure in selected patients and is considered as the only curative option in patients with secondary pulmonary malignancy. But surgical resection remains controversial due to the lack of randomized trials, comparing pulmonary metastasectomy to control, either medical therapy, or observation. This article will discuss the differentiated therapeutic strategies for patients with pulmonary metastases of colorectal cancer, focusing on surgical resection, patient evaluation, prognostic factors, interdisciplinary therapeutic approaches and current trials.     

Liver metastases from colorectal cancer: Technique of liver resection

Liver resection has become standard for the treatment of metastatic colorectal cancer (CRC): anterior approach, hanging manoeuvre, or total vascular exclusion techniques as well as 3‐dimensional imaging enable safe resections even in difficult cases. Furthermore, modern chemotherapy, portal vein embolization/ligation, and two‐stage procedures increase the resectability of metastasis, and repeat resections are feasible for recurrence. In addition to characteristics of the primary, CEA, extent of metastasis, resection margins, and extrahepatic disease, hilar lymph node metastases appear prognostic. J. Surg. Oncol. 2013;107:579–584. © 2012 Wiley Periodicals, Inc.     

78例脑膜转移癌患者的预后因素分析

目的：探讨影响脑膜转移癌（LM）患者生存的预后因素。方法：收集78例 LM患者的临床资料及随访资料,分析治疗及随访的数据,并分析影响总生存期的因素。应用 Cox 风险模型检验性别、年龄、KPS 评分、确诊时间、脑转移、其他器官转移、近期疗效、系统治疗、鞘内化疗、全脑化疗和脑脊液（CSF）细胞检测结果与患者总生存期的关系。结果：本组患者中位生存时间为62天;单因素分析显示：年龄、确诊时间、KPS 评分、全身系统治疗、近期疗效、脑脊液中癌细胞变化与患者总生存期相关。多因素分析结果显示：年龄、KPS 评分、近期疗效是影响患者生存的独立预后因素。结论：年龄、KPS 评分、近期疗效是影响患者生存的独立预后因素。     

Lymphocytic infiltration surrounding liver metastases from colorectal cancer

BACKGROUND AND OBJECTIVES: Tumor infiltrating lymphocytes (TILs) have been recognized as a tumor-host reaction in various primary neoplasms. Although several studies reported TILs surrounding metastatic liver tumors, to the authors' knowledge few evaluations of the clinical significance of such features in patients with colorectal liver metastases have been carried out. METHODS: Forty-one patients who underwent initial hepatic resection for liver metastases from colorectal cancer were studied. Lymphocytic infiltration surrounding metastatic liver tumor was graded as weak or dense according to the mean number of TILs from 10 high-power microscopic fields (< or =50 or >50/HPF). RESULTS: Dense lymphocytic infiltration between the metastatic tumor and hepatic parenchyma was seen in 18 of 41 patients (44%). Histologically, tumor invasion of the portal vein was rare in patients with dense TILs (12%) compared with patients with weak TILs (36%). Patients with dense TILs survived longer than patients with weak TILs after hepatic resection (P = 0.013). Multivariate analysis using the Cox proportional hazard model identified this pathological variable as a significant independent prognostic factor after hepatic resection. CONCLUSIONS: The extent of lymphocytic infiltration between the metastatic nodule and hepatic parenchyma may reflect host defensive activity in the liver and is closely related to prognosis in patients who underwent hepatic resection for liver metastases from colorectal cancer.     

肝移植在结直肠癌肝转移中的价值

结直肠癌是全球范围内发病率和死亡率均高的恶性肿瘤之一,早期容易发生转移,而肝脏恰是结直肠癌远处转移的最常见器官.随着肝移植技术的发展与进步,不可切除性结直肠癌肝转移患者获得了长期生存的新机遇.近年来,挪威奥斯陆大学医院在肝移植治疗不可切除性结直肠癌肝转移的领域中取得了一系列巨大突破,引起了世界各地学者的广泛关注.随后,...     

血脂与结直肠癌肝转移关系的临床研究

目的:检测结直肠癌患者的血脂水平,包括总胆固醇(TC)和甘油三酯(TG),探讨血脂异常与结直肠癌肝转移的关系.方法:收集本院282例结直肠癌患者的临床病理资料并检测空腹血脂水平.测定患者血清白蛋白和计算体重指数(BMI)评估患者的营养状态,对血脂等临床病理因素与结直肠癌肝转移的关系进行统计学分析.结果:结直肠癌肝转移患者的高胆固醇血症及高甘油三酯血症比率高于无肝转移者,差异有统计学意义(P＜0.05).多元Logistic回归分析显示,高胆固醇血症是结直肠癌发生肝转移的独立危险因素之一,而与高甘油三酯血症无关.结论:高胆固醇血症与结直肠癌肝转移相关,血脂水平的增高可能促进结直肠癌肝转移.     

Clinicopathological features and outcome in advanced colorectal cancer patients with synchronous vs metachronous metastases

Background:

Synchronous metastases of colorectal cancer (CRC) are considered to be of worse prognostic value compared with metachronous metastases, but only few and conflicting data have been reported on this issue.

Methods:

We retrospectively investigated patient demographics, primary tumour characteristics and overall survival (OS) in 550 advanced CRC patients with metachronous vs synchronous metastases, who participated in the phase III CAIRO study. For this purpose only patients with a prior resection of the primary tumour were considered.

Results:

The clinical and pathological characteristics associated with poor prognosis that we observed more often in patients with synchronous metastases (n=280) concerned an abnormal serum lactate dehydrogenase (LDH) concentration (P=0.01), a worse WHO performance status (P=0.02), primary tumour localisation in the colon (P=0.002) and a higher T stage (P=0.0006). No significant difference in median OS was observed between patients with synchronous metastases and metachronous metastases (17.6 vs 18.5 months, respectively, P=0.24).

Conclusion:

Despite unfavourable clinicopathological features in patients with synchronous metastases with a resected primary tumour compared to patients with metachronous metastases, no difference in the median OS was observed. Possible explanations include a (partial) chemoresistance in patients with metachronous disease because of previous adjuvant treatment, whereas differences between the two groups in screening procedures resulting in a lead time bias to diagnosis or in prognostic molecular markers remain speculative.     

FOLFOX6 and bevacizumab in non-optimally resectable liver metastases from colorectal cancer

Background:

In patients with colorectal liver metastases (CLM) R0 resection significantly improves overall survival (OS).

Methods:

In this report, we present the results of a phase II trial of FOLFOX6+bevacizumab in patients with non-optimally resectable CLM. Patients received six cycles of FOLFOX6+ five of bevacizumab. Patients not achieving resectability received six additional cycles of each. A PET-CT was performed at baseline and again within 1 month after initiating treatment.

Results:

From September 2005 to July 2009, 21 patients were enrolled (Male/Female: 15/6; median age: 65 years). An objective response (OR) was documented in 12 cases (57.1% complete responses (CRs): 3, partial response (PR): 9); one patient died from toxicity before surgery. Thirteen patients underwent radical surgery (61.9%). Three (23%) had a pathological CR (pCR). Six patients (46.1%) experienced minor postsurgical complications. After a median 38.8-month follow-up, the median OS was 22.5 months. Patients achieving at least 1 unit reduction in Standard uptake value (SUV)max on PET-CT had longer progression-free survival (PFS) (median PFS: 22 vs 14 months, P=0.001).

Conclusions:

FOLFOX6+bevacizumab does not increase postsurgical complications, yields high rates of resectability and pCR. Early changes in PET-CT seem to be predictive of longer PFS.