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。     

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。     

结直肠癌肝转移患者的预后因素分析

目的：分析结直肠癌伴肝转移患者手术切除后影响术后生存率的危险因素。方法：回顾性分析54例手术治疗的结直肠癌肝转移患者的临床及随访资料,对相关因素行单因素和多因素分析。结果：单因素分析显示,原发癌分化程度、淋巴转移、肝转移灶数目、肝转移灶肿瘤大小、手术方式及是否术后进行综合治疗等为影响患者预后的因素（均P<0.05）;多因素分析表明,手术方式、淋巴结转移和原发肿瘤分化程度是主要危险因素（均P<0.05）。结论：及早发现并进行根治切除以及加强术后综合治疗是提高本病远期疗效的关键。

     

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.     

胃癌肝转移外科治疗的临床分析

目的 评价胃癌肝转移的外科治疗效果及病理因素对其预后的影响。方法 本组834例胃癌患者中共有91例诊断为肝转移，其中79例为同时性肝转移，12例术后发现异时转移，共21例行胃癌肝转移灶切除术。结果 胃癌肝转移灶切除后1年、3年生存率分别为69％、30％。单转移灶及异时性转移是其有利的预后因素。13例肝转移灶有假包膜形成。结论 单转移灶及异时转移、肿瘤假包膜形成预示胃癌肝转移切除患者有较好的预后。     

大肠癌肝脏转移患者同期外科治疗的远期生存状况分析

目的通过比较同期外科切除的大肠癌肝脏转移患者的临床资料,研究影响其远期生存状况的相关因素。方法回顾性分析2009年1月至2010年12月于我院行同期手术切除的70例大肠癌肝脏转移患者的完整临床资料,观察患者术后的短期及长期疗效,采用单因素与多因素回归分析,研究70例结直肠癌肝转移患者的5年生存情况及影响其远期生存的相关因素。结果本组患者术后30 d无死亡,其中位生存时间为46个月,1年生存率为78.57%,2年生存率为55.71%,3年生存率为48.57%,5年生存率为42.86%;全部70例患者有66例的肝转移灶获得R0切除,包括52例楔形切除、13例半肝切除以及1例扩大切除;另4例为R1切除。并发症共发生9例,占12.86%。单因素分析显示淋巴结转移、术前化疗、肝转移病灶数、肝转移最大直径、癌胚抗原水平以及糖链抗原199对患者的生存率有影响(P0.05),而年龄、性别、原发瘤位置、肿瘤类型、病理类型、肝转移灶分布对患者的生存率无影响(P0.05)。多因素分析结果显示,淋巴结转移、术前化疗、肝转移病灶数、转移灶最大直径是影响患者生存率的独立预后因素。结论淋巴结转移、术前化疗、肝转移病灶数、转移灶最大直径是影响患者远期生存的独立预后因素。     

影响3cm以下小肝癌患者术后生存因素的观察

目的 总结小肝癌的手术治疗经验,探讨影响其术后生存率的临床、病理因素。方法回顾性分析1986年1月-2003年12月间手术切除并获得随访的105例小肝癌(≤3cm)的临床、病理资料,中位随访时间33个月。对有无结节性肝硬化、肝功能Child分级、术前血清AFP水平、肿瘤大小、有无肿瘤包膜、肿瘤分化程度(Edmondson分级)、有无门静脉癌栓、肿瘤是否多灶性(包括卫星灶)及手术方式等9项临床、病理参数与术后生存率及无瘤生存率的关系进行单因素及Cox模型多因素分析。结果截止2004年5月,手术后1、3、5年生存率分别为86．5%、70．3％、55．2％,无瘤生存率分别为78．0％、58．9％、45．6％。再次手术死亡1例。随访期内36例肝内复发,34例死亡。单因素及多因素分析均提示术前肝功能Child分级、肿瘤大小、门静脉癌栓及肿瘤多灶性是影响手术后生存率的预后因素,多因素分析显示肿瘤大小、门静脉癌栓及多灶性是影响手术后无瘤生存率的预后因素。结论距肿瘤1cm以上切缘的局部切除是治疗小肝癌的合理手术方式,手术后的肝内复发和转移及肝功能不良是导致小肝癌患者术后死亡的主要原因。     

胃癌伴肝转移的治疗及预后分析

目的探讨胃癌伴肝转移的治疗方法及其疗效。方法回顾性分析我院1999年1月-2003年12月间经手术治疗的36例胃癌伴同时性肝转移患者的临床资料,其中原发灶及转移灶同步切除17例,对未切除的肝转移灶行无水酒精瘤体内注射＋门静脉化疗栓塞等局部治疗19例,并与1995年1月-1999年12月间收治条件类似的16例胃癌原发灶切除而对肝转移灶未治疗的患者进行比较。结果肝转移灶切除组的术后1年、3年生存率分别为65％、29％,肝转移灶局部治疗组术后1年、3年生存率分别为53％、26％,两组之间相比差异无统计学意义（P〉0．05）;肝转移灶未治疗组术后1年、3年生存率分别为19％、0,较肝转移灶局部治疗组1年、3年生存率低,两组之间差异有统计学意义（P〈0．01）。结论对胃癌肝转移灶无法切除者应积极行转移灶的局部治疗,可明显改善患者的预后。     

外科治疗胃癌肝转移疗效分析

目的探讨外科治疗胃癌肝转移的方法与疗效。方法1996年1月至2003年12月间行外科治疗的胃癌肝转移患者25例，17例为同时性肝转移，8例为术后发现的异时性肝转移。其中单转移灶15例，多转移灶10例。行不规则肝切除16例，左外叶切除4例，左叶切除3例，右叶切除2例，术后行肝动脉灌注化疗9例，肝动脉化疗栓塞16例。结果1例同时性肝切除患者术后死于肺部感染、成人呼吸窘迫综合征，余24例均获随访，中位时间25(7—60)个月。胃癌肝转移灶切除后1、3年生存率为68．5％和29．8％，原发癌浸润表浅、淋巴结转移少、单转移灶、异时性转移及转移灶有包膜是影响生存率的有利因素。结论同时及异时性胃癌肝转移可经外科手术切除肝转移灶，但应注意手术指征的把握。     

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.     

Hepatic Resection for Metastatic Tumors From Gastric Cancer

OBJECTIVE: To assess the surgical results and clinicopathologic features of hepatic metastases from gastric adenocarcinoma to identify patients with a better probability of survival. SUMMARY BACKGROUND DATA: Many studies have reported the benefit of hepatic resection for metastatic tumors from colorectal cancer. However, indications for a surgical approach for gastric adenocarcinoma involving the liver have not been clearly defined. METHODS: Ninety (11%) of 807 patients with primary gastric cancer were diagnosed with synchronous (n = 78) or metachronous (n = 12) hepatic metastases. Of these, 19 underwent 20 resections intended to cure the metastatic lesion in the liver. The clinicopathologic features of the hepatic metastases in, and the surgical results for, the 19 patients were analyzed. RESULTS: The actuarial 1-year, 3-year, and 5-year survival rates after hepatic resection were, respectively, 77%, 34%, and 34%, and three patients survived for more than 5 years after surgery. Solitary and metachronous metastases were significant determinants for a favorable prognosis after hepatic resection. Pathologically, a fibrous pseudocapsule between the tumor and surrounding hepatic parenchyma was found in 13 of the 19 patients (68%). The presence of a peritumoral fibrous pseudocapsule and a well-differentiated histologic type of metastatic nodule were significant prognostic factors. Factors associated with the primary lesion were not significant prognostic determinants in patients who underwent curative resection of the primary cancer. CONCLUSIONS: Solitary and metachronous metastases from gastric cancer should be treated by a surgical approach and confer a better prognosis. A new prognostic factor, the presence of a pseudocapsule, may be helpful in defining indications for postoperative adjuvant treatment.     

胃癌同时性肝转移手术患者的预后分析

目的分析经手术治疗的胃癌同时性肝转移患者的预后因素。方法回顾性分析1998年1月至2012年12月间在大连医科大学附属第一医院胃肠外科手术治疗的胃癌同时性肝转移53例患者的临床病理学资料,对单发和多发肝转移患者的生存率进行比较并进行预后分析。结果本组53例患者5年总体生存率为11．3％。单发肝脏转移患者34例,5年生存率14．7％,明显高于19例多发肝转移患者的0（P=-0．000）。单因素分析结果显示,浆膜侵犯（P=0．000）、淋巴结转移（P=0．000）、手术根治度（P=0．044）、发生肝转移数目（P=0．000）和肝转移肿瘤直径（P=0．031）是影响胃癌肝转移患者预后的因素。其中浆膜侵犯（RR：3。355,P=0．012）和肝转移数目（RR：7．664,P=0．000）是影响胃癌肝转移患者预后的独立因素。结论手术治疗可以提高无浆膜侵犯的胃癌单发肝转移患者的预后。     

Analysis of the prognostic factors and evaluation of surgical treatment for synchronous liver metastases from gastric cancer

Background and aims  Whether or not a synchronous resection of liver metastases from gastric cancer provides a survival benefit has been a key issue. We identify the significant prognostic factors and clarify the beneficial effect on the survival of liver surgical treatment. Materials and methods  We reviewed 72 patients who underwent a gastrectomy for gastric cancer with synchronous liver metastases and classified the liver metastases into three grades, such as H1: metastases were limited to one of the lobes, H2: there were a few scattered metastases in both lobes, and H3: there were numerous scattered metastases. Results  H1, 2 metastases, and an absence of peritoneal dissemination (P0) were significantly independent prognostic factors for liver metastases of gastric cancer. In addition, the cumulative 1 and 5-year survival rates of liver surgical treatment (hepatic resection and/or microwave coagulation therapy) were 80.0% and 60.0%, whereas the survival rates for non-hepatic surgical treatment were 36.4% and 0% in 26 patients with H1, 2, and P0. In those patients, the radical operation, the solitary metastatic liver tumor, and no-distant lymph node metastases were independent prognostic determinants of survival. Conclusion  The radical operation including the surgical treatment for metastatic liver tumors should be performed to improve the prognosis in gastric cancer patients with synchronous H1, 2, and P0.     

胃癌肝转移31例外科治疗体会

目的 探讨胃癌肝转移的外科治疗效果.方法 对我院1997年10月～2006年10月收治的原发性胃癌338例中伴肝转移的31例的临床资料进行回顾性分析.对其中施行同时性胃癌肝转移灶切除术(切除组)的19例和仅行胃癌根治术而未行肝转移灶切除术(未切除组)的12例的术后生存时间进行对比.结果 全组除1例术后死于肝功能衰竭外,其余30例均获得随访.胃癌肝转移灶切除术后1年、3年和5年生存率分别为83.3%、44.4%和33.3%;未切除组术后1年生存率为50.0%,3年及5年生存率为0.两组术后生存时间有显著性差异(P＜0.05).切除组病例中有68.4%在肿瘤和周围肝组织间形成纤维假膜.结论 假包膜形成是有利的预后因素.对于胃癌肝转移病人,特别是有假包膜形成者采用外科治疗预后更好.     

大肠癌同时性肝转移外科治疗的预后因素分析

目的探讨大肠癌同时性肝转移及其与预后有关的危险因素,提高大肠癌肝转移的诊治水平。方法回顾性分析1994年8月至2004年2月间收治的大肠癌同时性肝转移106例的临床资料,对15项临床病理指标进行统计分析,并用单因素分析和Logistic回归分析与同期收治的无复发性肝转移的大肠癌1052例进行比较。同时对大肠癌肝转移行根治性切除、姑息性切除和探查性手术的生存状况用KaplanMeier法和COX回归方法进行分析比较。结果单因素分析显示,肠梗阻、腹水、盆腔结节、腹膜侵犯、浆膜浸润、周围脏器受累以及肿瘤长径、浸润肠壁的周径、浸润深度都与大肠癌同时性肝转移显著相关;Logistic回归分析发现,浸润深度、浆膜浸润、盆腔转移结节和腹水是影响大肠癌同时性肝转移最重要的因素。根治性切除57例(53.8%),姑息性切除39例(36.8%)和探查性手术后10例(9.4%)平均生存期和中位生存期分别为41.0和34.0个月、23.6和18.0个月以及16.5和12.0个月,三组差异有统计学意义(P=0.0095)。手术方式、肿瘤部位和盆腔结节是影响大肠癌同时性肝转移预后的主要因素。结论大肠癌浸润达浆膜、有盆腔转移结节和腹水者可能合并肝转移,根治性切除可以明显提高大肠癌同时性肝转移的生存率。     

Factors influencing survival of patients undergoing hepatectomy for colorectal metastases

BACKGROUND: The extent of surgical margin is still a matter of controversy with regard to outcome after liver resection for metastatic disease. The aim of this study was to clarify the significant prognostic factors after hepatectomy for colorectal metastases, with special reference to the surgical margin. METHODS: Ninety-six patients who underwent initial hepatic resection for liver metastases from colorectal cancer between 1992 and 1994 were studied. RESULTS: Overall 1-, 3- and 5-year survival rates were 94, 61 and 51 per cent respectively. All of the independent factors associated with poor prognosis after hepatic resection were tumour-related factors, such as the number of tumours (four or more), presence of portal vein invasion, hepatic vein invasion and absence of a fibrous pseudocapsule. A positive resection margin was not an independent prognostic factor, because of its strong relationship with the number of tumours resected. CONCLUSION: A generous surgical margin is not essential for curative hepatic resection, although positive surgical margins should be avoided. New potential risk factors which affect survival, such as the presence of portal vein or hepatic vein invasion and the absence of a pseudocapsule, may be helpful for defining the indications for postoperative adjuvant treatment.     

Surgical treatment of colorectal liver metastasis

The aim of this study was to evaluate retrospectively the long-term results of our approach, which consists of surgically treating every case in which radical resection of all metastatic disease was technically feasible. The indications for surgical resection for liver metastases from colorectal cancer remain controversial. Several clinical risk factors have been reported to influence survival. Between 1980 and 2001, 304 patients underwent curative hepatic resection for metastatic colorectal cancer at our institution. Survival rates and disease-free survival as a function of clinical and pathological determinants were examined retrospectively. The overall 3-, 5, 10-, and 20-year survival rates were 51%, 36%, 26%, and 25%, respectively. The stage of the primary tumor, lymph node metastasis, multiple nodules, a high preoperative CEA level and a short interval between treatment of the primary and metastatic tumors were significantly associated with a poor prognosis. Patients with 4 or more metastases had almost the same survival rate as those with 2 or 3 nodules. Extrahepatic metastases or invasion at hepatectomy did not worsen the survival rate if curatively resected. These results confirm that surgical resection is useful for treating liver metastases from colorectal cancer. While multiple metastases significantly impair patient prognosis, the life expectancy of patients with 4 or more nodules makes their resection mandatory.