结直肠癌肝转移的临床病理特征与术后生存关系分析

目的通过分析结直肠癌肝转移临床病理学特征与术后生存因素的相互关系,寻找更多更准确的能够影响预后的指标对预后生存的影响,为结直肠癌肝转移患者的治疗策略提供参考。方法回顾性分析第二军医大学东方肝胆外科医院2006年1月至2009年12月期间收治并经手术治疗的233例结直肠癌肝转移患者的临床资料,采用Kaplan-Meier法计算生存率及生存曲线,并进行单因素分析,采用log-rank法进行统计学检验。将经单因素分析对预后有统计学意义的危险因素带入COX多因素回归模型,计算独立预后因素。结果本组患者术后中位生存期为37.0个月,术后1、3及5年累积生存率分别为93.0%、61.0%、17.0%。接受根治性手术患者的术后中位生存期、3及5年累积生存率优于姑息性手术者:40.53个月比27.20个月、59.0%比29.0%、20.0%比0(P0.05)。对于总体生存期而言,单因素分析结果显示,手术方式、肝转移瘤切除术后首次复发时间、肝内转移灶数目、肝内转移灶最大直径、手术切缘、肝外不可切除转移灶及周围组织或器官侵犯、是否合并慢性肝病(慢性肝炎、脂肪肝、肝硬变)、术前血清CEA水平、CA19-9水平、是否为同时性肝转移、原发灶TNM分期、肝转移瘤生长位置和肝转移瘤包膜是否完整这13项是影响预后的因素(P0.05);COX多因素分析结果显示,姑息性手术方式、同时性肝转移、肝转移瘤生长位置广泛、肝转移瘤无完整包膜、肝内转移灶多发、肝内转移灶最大直径3 cm、存在肝外不可切除转移灶及周围组织或器官侵犯和未合并慢性肝病(慢性肝炎、脂肪肝、肝硬变)这8项因素是对结直肠癌肝转移患者术后生存产生影响的独立危险因素(P0.05)。结论手术治疗可以使结直肠癌肝转移患者获得长期生存,姑息性手术方式、同时性肝转移、肝转移瘤生长位置广泛、肝转移瘤无完整包膜、肝内转移灶多发、肝内转移灶最大直径3 cm,存在肝外不可切除转移灶及周围组织或器官侵犯、未合并慢性肝病(慢性肝炎、脂肪肝、肝硬变)等是影响结直肠癌肝转移患者术后预后的独立危险因素。     

结直肠癌肝转移的外科治疗

目的探讨结直肠癌肝转移的外科手术适应证和疗效,以及临床病理因素对其预后的影响。方法回顾性分析1991年1月至2000年12月间施行肝切除术的61例结直肠癌肝转移患者的临床资料。结果结直肠癌肝转移切除术后1、3、5年生存率分别为72.1%、58.1%和26.0%,术后出现并发症8例,20例肝转移灶有假包膜形成。结直肠癌Dukes分期、病理类型、转移灶数目、假包膜形成对术后生存率有影响(P<0.05)。术后综合治疗者3年生存率明显优于无综合治疗者(P<0.05)。肝转移灶大小及其切除时间并不影响患者预后(P>0.05)。结论临床病理分期早、肿瘤分化程度高、转移灶数目不超过3个、肿瘤假包膜形成及术后综合治疗预示结直肠癌肝转移切除患者有较好的预后。     

结直肠癌肝转移复发再次肝切除术的疗效与预后分析

目的 探讨再次肝切除术在结直肠癌肝转移复发治疗中的应用价值.方法 回顾性分析43例结直肠癌肝转移复发再次肝切除术和67例结直肠癌肝转移复发内科化疗的临床资料.结果 结直肠癌肝转移复发再手术组和化疗组1,3,5年生存率分别为83.7％,51.1％,27.9％和65.7％,20.6％,3.0％(P＜0.05或P＜0.01).再次肝切除组无手术死亡病例,并发症发生率为32.6％.单因素分析显示肝脏复发转移灶个数,切缘情况,CEA,肿瘤大小,肿瘤分化程度与预后有关.多因素回归分析结果表明,仅有肝脏复发转移灶个数和肿瘤大小为影响预后的独立因素.结论 再次肝切除术对于结直肠癌肝转移复发是安全的治疗方案,肿瘤负荷较小(癌直径＜5 cm和转移灶＜3个)的患者预后较好;再次手术可以延长结直肠癌肝转移复发患者的生存时间.     

胃癌根治术后肝转移的预后分析

目的探讨影响胃癌根治术后肝转移患者预后的相关因素。方法总结我院1996年至2001年间收治的胃癌根治术后发生肝转移患者87例的临床病理资料，回顾分析影响所有胃癌根治术后肝转移患者预后的相关临床病理因素。结果胃癌根治术后肝转移患者1、3和5年生存率分别为28．8％、3．6％和0，平均生存时间为（11．3±1．1）个月。单因素分析显示：原发灶部位、原发灶大小、分化程度、浸润深度、Lauren分型、淋巴结转移、血管浸润、神经浸润、腹膜转移、转移灶数目、转移灶肝内分布类型及转移灶切除与胃癌根治术后肝转移的预后显著相关。而多因素分析显示：仅原发灶部位、Lauren分型、转移灶肝内分布类型和转移灶切除是影响胃癌根治术后肝转移预后的独立因素。结论原发灶部位、Lauren分型、转移灶肝内分布类型和转移灶切除与否是评价胃癌根治术后肝转移患者预后的重要参考因素。     

结直肠癌肝转移的手术治疗

目的 探讨手术治疗结直肠癌肝转移的疗效以及影响因素.方法 收集74例手术治疗的结直肠癌肝转移病例,进行回顾性分析.结果 本组患者3年和5年生存率分别为63.8%和49.8%.原发灶淋巴结转移者5年生存率(33.3%)显著低于无转移者(63.7%,P=0.002),脉管侵犯者(39.6%)显著低于无侵犯者(61.6%,P=0.025).转移灶个数≤3个者(53.7%)显著高于＞3个者(34.6%,P=0.021).肝转移灶局限于半肝者,其5年生存率(65.2%)显著高于双侧弥漫者(23.9%,P=0.001).结论 手术切除是唯一可能治愈结直肠癌肝转移的方法.原发灶无淋巴结转移、无脉管侵犯,转移灶个数不超过3个、局限于半肝者预后较好.     

结直肠癌同时性肝转移手术时机的选择

目的 探讨可切除性结直肠癌同时性肝转移的手术时机.方法 回顾性分析2009年10月至2011年11月上海交通大学医学院附属仁济医院收治的5例结直肠癌伴同时性肝转移患者的临床资料,根据患者的情况分别行手术治疗+辅助化疗、新辅助化疗或靶向治疗.结果5例患者均行手术+术后辅助治疗.3例原发灶和肝转移灶可切除者,1例先行新辅助化疗,肝转移灶明显缩小后一期手术切除原发灶和肝转移灶,术后6个月MRI检查发现肝内复发;1例未行新辅助化疗,术后9个月CT检查发现肺内多发转移灶;1例因原发灶穿孔腹腔感染,先切除原发灶,术后化疗+靶向治疗,二期切除肝内转移灶,术后12个月CT检查发现肺内单发转移灶.其余2例因肝内多发性转移灶无法手术切除,仅切除原发灶,1例术后13个月死于骨转移;另1例行辅助化疗+靶向治疗,CT检查示肝内转移灶曾一度进行性缩小,但术后11个月开始肝内转移灶渐增多、增大.5例患者术后均行k-ras基因检测,除病例2的Condon 12位点为野生型、Condon 13位点为突变型外,其余患者均为野生型.结论新辅助化疗或新辅助化疗+靶向治疗的效果个体差异大,消灭体内微转移灶作用有限,首选一期手术切除原发灶和同时性肝转移灶有可能使患者获益最大.     

结直肠癌肝转移的外科治疗现状

结直肠癌肝转移实施肝叶切除是有效的治疗方法 ,切除率和术后生存率均已有明显提高。对于肝切除术后复发是否再次切除 ,以及肝外转移灶及肝门淋巴结的处理尚有争论。作者复习文献并对此方面的进展加以综述。一、结直肠癌肝转移的首选治疗———肝叶切除术结直肠癌发生肝转移同期行结肠切除和肝转移灶的切除可望获得较高的肝切除后 5年存活率。原发灶切除后发现的肝转移 ,肝叶切除后同样能长期存活。切除后的 5年存活率达 16%～ 45 % ,手术死亡率在 5 %以下〔1～ 3〕。直肠癌肝转移是可治愈的 ,肝切除是安全的、也是最有效的治疗〔4～ 6〕,并…     

结直肠癌肝转移的外科治疗

目的探讨结直肠癌肝转移的手术疗效。方法1996年8月～2000年8月手术治疗结直肠癌肝转移患者31例,行原发癌与转移癌同时切除者9例,结直肠癌根治术后6月再切除肝转移灶者18例;切除肝转移灶后2月再切除原发病灶者4例。原发灶行右半结肠切除5例,横结肠切除4例,左半结肠切除7例,Dixon术12例,Miles术3例。肝转移灶行左外叶切除5例,左半肝切除2例,右后叶切除4例,右前叶切除2例,左或右肝不规则切除18例。结果全组无手术死亡。术后粘连性肠梗阻1例,切口感染3例,经对症治疗后均痊愈出院。平均随访6.4(0.5～8)年,1、2、5年生存率分别为100%、80.6%、29.0%。同期手术者与分期手术者5年生存率分别为33.3%和27.3%,无统计学差异(P>0.05)。结论对结直肠癌肝转移患者应积极争取手术切除,术后可配合其他综合治疗;对原发灶早期诊断、早期手术治疗及辅助化疗有利于防止结直肠癌肝转移。     

结直肠癌肝转移综合治疗预后因素分析（附317例报告）

目的 探讨影响结直肠癌肝转移以外科手术为主的综合治疗疗效的预后风险因素。方法 回顾性分析北京大学肿瘤医院肝胆胰外一科2005年1月至2015年1月行肝切除手术治疗317例结直肠癌肝转移病人的临床资料及术后随访情况。结果 全组病人1、3、5年总存活率分别为90.5%、54.5%、45.0%。中位生存期43个月。单因素分析结果显示性别、原发灶淋巴结转移、肝转移灶最大径、肝转移灶出现时间、癌胚抗原（CEA）水平及是否存在肝外转移灶是影响预后的因素（P<0.05）;多因素分析结果显示原发灶淋巴结转移、同时性肝转移和CEA>30 μg/L是影响预后的独立危险因素。结论 以外科手术为主的综合治疗可显著改善结直肠癌肝转移病人的长期生存,多种临床风险因素影响病人预后。     

Twist 蛋白在结直肠癌和肝转移组织中的表达及临床意义

目的：探讨Twist蛋白在结直肠癌及肝转移组织中的表达及其临床意义。方法选取2001年1月至2012年12月伴有肝转移的结直肠癌患者成套组织标本（原发灶、肝转移灶、距肿瘤边缘10 cm以上的正常结直肠黏膜组织）54例患者。采用免疫组织化学SP法检测54例患者标本的原发灶、肝转移灶及正常结直肠黏膜组织中Twist蛋白的表达,数据分析处理采用SPSS 19．0统计软件包,计数资料采用R ＆#215;C表资料的χ2检验,生存分析采用Kaplan-Meier生存曲线法,Log-rank检验分析肿瘤浸润程度、淋巴结转移、组织学分型及Twist蛋白在原发灶及肝转移灶中表达的情况,采用Cox回归模型进行独立预后因素分析。结果 Twist蛋白在结直肠癌原发灶中的阳性表达率明显高于肝转移灶、正常结直肠黏膜组织（P＜0．001）;原发灶中Twist蛋白在不同浸润深度T2、T3、T4的阳性表达率分别为30．0％、64．9％、85．7％,其差异有统计学意义（P＝0．049）;单因素分析显示,原发灶及肝转移灶中Twist蛋白阳性表达组患者的总体生存率均显著低于阴性表达组（P＝0．034,P＝0．031）;多因素生存分析证实肿瘤浸润深度、淋巴结转移和肿瘤组织学分型为影响患者总体生存率的独立因素（P＜0．001,P＝0．002,P＝0．005）,而Twist蛋白在原发灶及肝转移灶中的表达不是总体生存率的独立因素（ P＝0．548,P＝0．742）。结论 Twist蛋白在结直肠癌肝转移患者的原发灶高表达,其可能参与结直肠癌肝转移的发生,对评价结直肠癌肝转移患者预后具有一定临床意义。     

Recurrence at surgical margin following hepatectomy for colorectal liver metastases is not associated with R1 resection and does not impact survival

BackgroundResection margin status has traditionally been associated with tumor recurrence and oncological outcome following liver resection for colorectal liver metastases. Previous studies, however, did not address the impact of resection margin on the site of tumor recurrence and did not differentiate between true local recurrence at the resection margin and recurrence elsewhere in the liver. This study aimed to determine whether positive resection margins determine local recurrence and whether recurrence at the surgical margin influences long-term survival.MethodsClinicopathological data and oncological outcomes of patients who underwent curative resection for colorectal liver metastases between 2012 and 2017 at 2 major hepatobiliary centers (Bern, Switzerland, and Berlin, Germany) were assessed. Cross-sectional imaging following hepatectomy was reviewed by radiologists in both centers to distinguish between recurrence at the resection margin, defined as hepatic local recurrence, and intrahepatic recurrence elsewhere. The association between surgical margin status and location of tumor recurrence was evaluated, and the impact on overall survival was determined.ResultsDuring the study period, 345 consecutive patients underwent hepatectomy for colorectal liver metastases. Histologic surgical margins were positive for tumor cells (R1) in 63 patients (18%). After a median follow-up time of 34 months, tumor recurrence was identified in 154 patients (45%). Hepatic local recurrence was not detected more frequently after R1 than after R0 resection (P = .555). Hepatic local recurrence was not associated with worse overall survival (P = .436), while R1 status significantly impaired overall survival (P = .025). Additionally, overall survival was equivalent between patients with hepatic local recurrence and patients with any intrahepatic and/or extrahepatic recurrence. In patients with intrahepatic recurrence only, oncological outcomes improved if local hepatic therapy was possible (resection or ablation) in comparison to patients treated only with chemotherapy or best supportive care (3-year overall survival: 85% vs 39%; P < .0001).ConclusionThe incidence of hepatic local recurrence after hepatectomy for colorectal liver metastases is independent of R1 resection margin status. Additionally, hepatic local recurrence at the resection margin is not associated with worse overall survival compared with any other intra- or extrahepatic recurrence. Therefore, R1 status at hepatectomy seems to be a surrogate factor for advanced disease without influencing location of recurrence and thereby oncological outcome. This finding may support decision-making when extending the indication for surgery in borderline resectable colorectal liver metastases.     

Analysis of predictive factors for recurrence after hepatectomy for colorectal liver metastases

Hepatectomy for liver metastases from colorectal cancer has recently received general acceptance as a safe, potentially curative treatment. Most patients, however, die of recurrent disease after hepatectomy. The predictive factors for recurrence after first resection of liver metastases have not yet been clarified. The authors aimed to determine the factors that can predict recurrence, especially hepatic-only recurrence after hepatectomy for colorectal liver metastases. Seventy-six patients who underwent liver resection of colorectal metastases were studied retrospectively. Forty-seven (61.8%) of the patients had a recurrence. The patients' disease-free survival after first hepatectomy and the second recurrence sites were univariately and multivariately analyzed using 16 clinicopathologic variables. Wall invasion, lymph node metastases, lymphatic invasion, venous invasion of the primary tumor, 24 months or longer disease-free interval after resection of the primary colorectal cancer, and bilateral liver metastases significantly influenced the disease-free survival (log-rank test: p < 0.05). The multivariate analysis revealed that venous invasion of the primary tumor and bilateral hepatic metastases were independent risk factors for recurrence after hepatectomy. The liver was the only site of second recurrence in 23 patients. Patients with lymph node metastases and venous invasion of the primary tumor had a significant difference between hepatic-only and extrahepatic recurrence after first hepatectomy (chi-square test or Fishers' exact test: p < 0.05). Recurrence after hepatectomy was influenced more by factors associated with the primary colorectal cancer than factors surrounding the first liver metastases. Venous invasion of the primary colorectal cancer was the most important predictable factor for hepatic-only second recurrence.     

Intrahepatic Lymphatic Invasion Independently Predicts Poor Survival and recurrences after Hepatectomy in Patients with Colorectal Carcinoma Liver Metastases

BACKGROUND: D2-40 monoclonal antibody immunoreactivity is specific for lymphatic endothelium and therefore provides a marker of lymphatic invasion. We hypothesized that intrahepatic lymphatic invasion reflects the nodal status of colorectal carcinoma liver metastases and may function as an adverse prognostic factor. METHODS: A retrospective analysis of 105 consecutive patients who underwent resection for colorectal carcinoma liver metastases was conducted. Intrahepatic lymphatic invasion was declared when either single tumor cells or cell clusters were clearly visible within vessels that showed immunoreactivity for D2-40 monoclonal antibody. The median follow-up time was 124 months. RESULTS: Of 105 patients, 13 were classified as having intrahepatic lymphatic invasion. All tumor foci of intrahepatic lymphatic invasion were detected within the portal tracts. Intrahepatic lymphatic invasion was significantly associated with hepatic lymph node involvement (P = 0.039). Survival after resection was significantly worse in patients with intrahepatic lymphatic invasion (median survival time of 13 months; cumulative five-year survival rate of 0%) than in patients without (median survival time of 40 months; cumulative five-year survival rate of 41%; P < 0.0001). Patients with intrahepatic lymphatic invasion also showed decreased disease-free survival rates (P < 0.0001). Intrahepatic lymphatic invasion thus independently affected both survival (relative risk, 7.666; 95% confidence interval, 3.732-15.748; P < 0.001) and disease-free survival (relative risk, 4.112; 95% confidence interval, 2.185-7.738; P < 0.001). CONCLUSIONS: Intrahepatic lymphatic invasion is associated with hepatic lymph node involvement and is an adverse prognostic factor in patients with colorectal carcinoma liver metastases.     

Effect of surgical margin status on survival and site of recurrence after hepatic resection for colorectal metastases

OBJECTIVE: To evaluate the influence of surgical margin status on survival and site of recurrence in patients treated with hepatic resection for colorectal metastases. METHODS: Using a multicenter database, 557 patients who underwent hepatic resection for colorectal metastases were identified. Demographics, operative data, pathologic margin status, site of recurrence (margin, other intrahepatic site, extrahepatic), and long-term survival data were collected and analyzed. RESULTS: On final pathologic analysis, margin status was positive in 45 patients, and negative by 1 to 4 mm in 129, 5 to 9 mm in 85, and > or =1 cm in 298. At a median follow-up of 29 months, the 1-, 3-, and 5-year actuarial survival rates were 97%, 74%, and 58%; median survival was 74 months. Tumor size > or =5 cm, >3 tumor nodules, and carcinoembryonic antigen level >200 ng/mL predicted poor survival (all P < 0.05). Median survival was 49 months in patients with positive margins and not yet reached in patients with negative margins (P = 0.01). After hepatic resection, 225 (40.4%) patients had recurrence: 21 at the surgical margin, 56 at another intrahepatic site, 82 at an extrahepatic site, and 66 at both intrahepatic and extrahepatic sites. Patients with negative margins of 1 to 4 mm, 5 to 9 mm, and > or =1 cm had similar overall recurrence rates (P > 0.05). Patients with positive margins were more likely to have surgical margin recurrence (P = 0.003). Adverse preoperative biologic factors including tumor number greater than 3 (P = 0.01) and a preoperative CEA level greater than 200 ng/mL (P = 0.04) were associated with an increased risk of positive surgical margin. CONCLUSIONS: A positive margin after resection of hepatic colorectal metastases is associated with adverse biologic factors and increased risk of surgical-margin recurrence. The width of a negative surgical margin does not affect survival, recurrence risk, or site of recurrence. A predicted margin of <1 cm after resection of hepatic colorectal metastases should not be used as an exclusion criterion for resection.     

Results of extensive surgery for liver metastases in colorectal carcinoma.

Hepatic resections were performed during the past 13 years on 31 patients with hepatic metastases from colorectal carcinoma. Of the 31 patients, 22 underwent lymph node dissection of the hepatic hilus. Ten patients underwent removal of recurrent lesions in the liver, lung, adrenal gland and brain after initial hepatic resection. The overall 5-year survival rate was 45 per cent. The outcome for six patients who underwent repeat hepatectomy after an initial hepatectomy was significantly better than for nine patients with unresectable recurrence (P less than 0.01). Six of the 22 patients who underwent lymph node dissection had nodes positive for tumour. Two of the six patients underwent repeat hepatectomy and are alive after 49 and 66 months. Three- and 4-year survival rates of patients with positive lymph nodes were both 40 per cent. Repeat hepatectomy and dissection of hilar lymph nodes improves prognosis in selected patients with hepatic metastases of colorectal cancer.     

Staging and indications for hepatectomy in hepatic metastases of colorectal cancer

Factors adversely affecting prognosis after hepatectomy for hepatic metastases include residual tumor, hepatic lymph node metastases, satellite metastases, extrahepatic metastases, four or more hepatic metastases, resection margins of less than 10 mm, and carcinoembryonic antigen and carbohydrate antigen 19-9 values higher than normal preoperatively and 1 month postoperatively. As no significant differences were observed in terms of the H-number stipulated by the Japanese Classification of Colorectal Carcinoma, a new staging system based on the number of lymph node metastases from the primary lesion, the number of liver metastases number, and the size of metastatic tumors was developed. The proposed staging system appears to be useful in predicting the prognosis of patients with metastatic liver tumors from colorectal cancer. Favorable patient selection criteria for liver resection are: 1) medical fitness for hepatectomy; 2) radical resection of the primary colorectal lesion; 3) metastatic tumors anatomically confined within the liver allowing adequate preservation of the liver parenchyma; 4) no signs of disseminated disease; 5) no signs of hepatic lymph node metastases; 6) four or fewer metastatic tumors; and 7) resection margins of 10 mm or greater. Unilobar or bilobar disease with multiple lesions is not a significant prognostic factor.     

Role of repeated hepatectomy in the multimodal treatment of hepatic colorectal metastases

HYPOTHESIS: Multimodal treatment consisting of repeated hepatectomy and adjuvant systemic chemotherapy for liver-confined recurrence of colorectal cancer can yield long-term survival comparable with that associated with primary hepatectomy. DESIGN: Retrospective analysis. SETTING: A prospective database at a tertiary referral cancer center. PATIENTS: Review of 274 consecutive liver resections identified 64 patients who underwent resection of hepatic colorectal metastases without ablation followed by adjuvant irinotecan hydrochloride- or oxaliplatin-based systemic chemotherapy. MAIN OUTCOME MEASURES: Median and 5-year overall and disease-free survival after primary and repeated hepatectomy. RESULTS: At median follow-up of 40 months, median and 5-year overall survival after hepatectomy were 60 months and 53%, respectively; median and 5-year disease-free survival were 33 months and 25%, respectively. Multivariate analysis showed that less than 1 year between colectomy and liver resection (P = .001), more than 3 metastases (P = .001), no repeated hepatectomy (P = .01), and lymph node-positive primary colon cancer (P = .02) were independently predictive of worse survival. Of 28 patients (44%) with liver-confined recurrence, 19 (30%) underwent repeated hepatectomy; at median follow-up of 38 months, median and 5-year overall survival after repeated hepatectomy were 48 months and 44%, respectively. No risk factors were identified in multivariate analysis. In patients with recurrence, median and 5-year overall survival measured from primary hepatectomy were 70 months and 73%, respectively, with repeated hepatectomy vs 43 months and 43%, respectively, without repeated hepatectomy (P = .03). CONCLUSION: Multimodal treatment of recurrent colorectal cancer confined to the liver should begin with consideration of repeated hepatectomy.     

Indications for surgical treatment of intrahepatic cholangiocarcinoma with lymph node metastases

BACKGROUND/PURPOSE: The postoperative outcome of patients who have intrahepatic cholangiocarcinoma with lymph node metastases is extremely poor, and the indications for surgery for such patients have yet to be clearly established. METHODS: The demographic and clinical characteristics of 133 patients who underwent lymph node dissection during hepatic resection of intrahepatic cholangiocarcinoma were retrospectively analyzed. RESULTS: Multivariate analysis identified three independent prognostic factors: intrahepatic metastasis, nodal involvement, and tumor at the margin of resection. Of the patients with tumor-free surgical margins, none of the 24 patients who had both lymph node metastases and intrahepatic metastases survived for 3 years. In contrast, the survival rates for the 23 patients who had lymph node metastases associated with a solitary tumor were 35% at 3 years and 26% at 5 years. CONCLUSIONS: Surgery alone cannot prolong survival when both lymph node metastases and intrahepatic metastases are present, while surgery may provide a chance for long-term survival in some patients who have lymph node metastases associated with a solitary intrahepatic cholangiocarcinoma tumor.     

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??Long-term survival after hepatectomy for metastatic colorectal cancer: A retrospective analysis of 317 consecutive cases at a single-institution YAN Xiao-luan, WANG Kun, BAO Quan, et al. Hepatobiliary and Pancreatic Surgery Unit I, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
Corresponding author: XING Bao-cai??E-mail: xingbaocai88@ sina.com
Abstract Objective To identify risk factors associated with overall survival(OS) for patients performed hepatic resection for metastatic colorectal cancer. Methods The clinical, pathologic, and complete follow-up data were prospectively collected from 317 consecutive patients performed primary hepatic resection for colorectal liver metastases at Beijing Cancer Hospital from January 2005 to January 2015. Parametric survival analysis was used to identify predictors of cancer-specific survival. Results The 1-, 3- and 5-year overall survival were 90.5%, 54.5% and 45.0%, respectively. The median survival time was 43 months. Univariate analysis found 6 risk factors including gender, lymph node dissemination of the primary tumor, diameter of metastases>3 cm, synchronous metastases, carcinoembyonic antigen level >30 μg/L, and extra-hepatic disease??P<0.05??. On multivariate analysis, 3 risk factors were found to be independent predictors of poor survival, which included lymph node dissemination of the primary tumor, synchronous metastases, CEA>30 μg/L. Conclusion Resection of liver metastases provides long-term cancer-specific survival benefit. Clinicopathological characteristics including lymph node dissemination of the primary tumor, synchronous metastases, CEA>30 μg/L were predictors of adverse outcome.     

胃癌肝转移的肝切除治疗及预后分析

目的 探讨胃癌肝转移肝切除治疗的疗效以及不同临床病理因素与预后的关系.方法 回顾性总结24例胃癌肝转移行肝转移灶手术切除患者的临床资料并对预后进行单因素和多因素分析.结果 全组病例均获得随访,胃癌肝转移外科治疗后1年生存率为67%,3年生存率为21%,5年生存率为13%.单因素分析显示淋巴结转移、脉管瘤栓、R0切除、转移灶大小为重要预后因素;多因素分析显示转移灶大小、脉管瘤栓为独立预后因素.结论 严格适应证的胃癌肝转移手术切除可以改善预后.综合治疗有望进一步提高疗效.