300例结直肠癌肝转移患者的临床预后分析

目的 探讨结直肠癌肝转移患者的临床特征及预后因素.方法 对300例结直肠癌首发肝转移患者的临床特征及肝转移后的生存情况进行回顾性分析.结果 300例患者中,原发病灶位于结肠者152例,位于直肠者148例.原发肿瘤为管状腺癌272例,黏液腺癌18例,类癌5例,印戒细胞癌4例,鳞癌1例.原发肿瘤为高分化19例,中分化217例,低分化27例.无区域淋巴结转移104例,有区域淋巴结转移162例.原发肿瘤分期为Ⅰ、Ⅱ期62例,Ⅲ、Ⅳ期为237例.同时性肝转移206例,异时性肝转移94例.肝转移灶为单发48例,多发252例.肝转移灶最大直经≤5 cm249例,>5 cm 51例.300例患者转移后中位生存期为19.0个月,肝转移后1、2和5年生存率分别为79.0%、29.0%和3.0%.单因素分析结果显示,患者KPS评分、组织学分级、原发肿瘤T分期、有无区域淋巴结转移、原发肿瘤分期、有无脉管瘤栓、肝转移灶部位、肝转移灶最大直径、肝转移灶数目、同时合并其他转移均与预后有关.多因素分析结果显示,KPS评分、脉管瘤栓、肝转移灶数目、肝转移灶最大直径是结直肠癌肝转移患者预后的独立影响因素.结论 KPS评分、脉管瘤栓、肝转移灶数目和最大直径是结直肠癌肝转移患者预后的影响因素,KPS评分越高、无脉管瘤栓、肝转移灶数目越少、转移灶最大直径越小的患者预后越好.     

220例结直肠癌同时肝转移患者临床预后分析

背景与目的:结直肠癌是国内常见的肿瘤之一,结直肠癌同时肝转移的发生率可高达10%～25%。本文探讨影响结直肠癌同时肝转移患者预后的因素和治疗的选择。方法:回顾性分析1995年12月至2002年12月中山大学肿瘤防治中心收治的初治结直肠癌同时肝转移患者220例,对其临床资料进行统计分析。用Kaplan-Meier法对结直肠癌同时肝转移患者的预后进行单因素分析,用Cox模型进行多因素分析。结果:本组病例5年生存率为5.52%,中位生存时间为12.93个月。用Kaplan-Meier及log-rank法对临床特征进行单因素生存分析,有统计学意义的变量因素包括:肝转移灶数目、肝转移灶最大径、肝转移灶分布、肝外是否存在侵犯或转移、确诊时CEA水平、局部区域淋巴结有无转移、病理类型。对临床治疗方式进行单因素生存分析,有统计学意义的变量因素包括:治疗方式、原发灶是否完全切除和化疗方案的选择。用Cox模型进行多因素分析后发现:肝转移灶分布肝叶数、肝转移灶最大径、肝外是否存在侵犯或转移、确诊时CEA水平、治疗模式、原发病灶是否切除、化疗方案为独立的预后危险因素。结论:对于结直肠癌同时肝转移的患者,肝转移灶最大直径超过5cm、肝转移灶分布超过一叶、存在肝外侵犯或转移灶和CEA水平超过200μg/L提示患者预后不良。对于仅有肝转移的结直肠癌患者应尽可能手术根治原发灶以及转移灶,对于手术不能切除的肝转移灶可考虑行全身化疗和/或介入治疗,全身化疗最好选用含草酸铂的方案。     

大肠癌伴肝转移患者的预后因素

目的探讨影响大肠癌伴肝转移患者预后的因素.方法1995年5月-1999年12月间本院外科手术治疗的64例大肠癌伴肝转移患者,部分患者全身化疗或肝动脉插管化疗,并对其临床资料进行统计分析.结果本组大肠癌肝转移患者占大肠癌患者10.2%.肝转移灶大小、术前CEA水平、原发灶切除、辅助治疗方式为影响生存的独立的预后因素.年龄、性别、肿瘤部位、分化程度、肝转移灶数目与预后无关.肝转移灶＞5cm、术前CEA＞100μg/ml、原发灶未切除的患者的生存时间(3.52月)显著低于其他患者(21.60月).结论治疗方式对肠癌肝转移患者预后影响显著,应积极切除原发灶、治疗转移灶.肝动脉插管化疗优于全身化疗.肝转移灶大小、术前CEA水平是重要的预后指标.     

结直肠癌肝转移患者生存情况及预后因素分析

目的 探讨结直肠癌肝转移患者的生存情况及其预后相关因素.方法 采用Kaplan-Meier和多因素回归分析方法,分析112例有完整随访资料的结直肠癌肝转移患者的生存情况及影响预后的相关因素.结果 112例患者的中位生存时间为18.3个月,1、2、3和5年生存率分别为60.8%、35.0%、20.3%和4.8%.单因素分析显示,患者性别、年龄、原发肿瘤部位、化疗与否、肿瘤的病理类型与患者的总生存时间无关(P＞0.05),而原发肿瘤治疗方法、肝脏转移时间、原发肿瘤大体类型、肝脏转移灶手术与否和临床分期与患者的预后有关(P＜0.05).多因素回归分析显示,肝脏转移灶手术与否、原发肿瘤大体类型和临床分期是影响结直肠癌肝转移患者预后的主要因素(P＜0.05).结论 对于结直肠癌肝转移的患者应积极切除肝转移病灶,延长患者生存时间.     

Resection of synchronous liver metastases from colorectal cancer

Background: The prognosis for patients with liver metastasesfrom colorectal cancer is still poor. Thus, patient selectionfor hepatic resection is essential to improve the poor resultsof the procedure. Some reports have shown that the prognosisfor patients with synchronous liver metastases is worse thanthat for those with metachronous liver metastases. Therefore,determination of the factors that influence outcome after resectionof synchronous liver metastases is more important than withmetachronous liver metastasis. Method: We studied patients who had been followed for more than5 years after undergoing resection of synchronous liver metastasesfrom colorectal cancer. Results: Among the 12 prognostic factors studied (age, gender,adjuvant chemotherapy, tumor site, CEA level, tumor differentiation,tumor size, regional lymph node metastatic status, distributionof liver metastases, number of liver metastases, tumor sizeand pathological margin), regional lymph node metastatic statusand pathological margin were significant prognostic factorsby univariate analysis (p = 0.0002 and 0.005, respectively).Regional lymph node metastatic status was a significant prognosticfactor by multivariate analysis (p = 0.031). The survival curveof patients with six or more regional lymph node metastaseswas similar to that of patients with non-resectable liver metastasis. Conclusion: The resection of synchronous liver metastases inpatients with six or more regional lymph node metastases isrelatively contraindicated. For these patients, other treatmentmodalities should be considered. ⁺ For reprints and all correspondence: Shin Fujita, Departmentof Surgery, National Cancer Center Hospital, 1–1 Tsukiji5-chome, Chuo-ku, Tokyo 104-0045, Japan. E-mail: sfujita@gan2.ncc.go.jp     

Hepatic lymph node involvement in patients with synchronous multiple liver metastases of colorectal cancer

BACKGROUND AND PURPOSE: Hepatic arterial infusion chemotherapy for unresectable liver metastases of colorectal cancer is generally indicated to patients without extra hepatic lesions. This study was performed to examine the status of hepatic lymph node metastasis as an extra hepatic lesion in patients with synchronous multiple liver metastases of colorectal cancer. PATIENTS AND METHODS: A total of 111 hepatic lymph nodes were removed from 33 patients with synchronous liver metastases of colorectal cancer during resection of the primary tumor at the D2- or D3- level. The frequency of hepatic lymph node metastases and factors predictive for hepatic lymph node metastasis were examined. RESULTS: Hepatic lymph node metastasis was detected in nine patients (27%): The sites were classified into three categories: (1) along the hepatic arteries in three, (2) in the hepato-duodenal ligament except the peri-hepatic arterial region in three, and (3) both in three. The serum level of CEA (p = 0.02), CA19-9 (p = 0.05), and the rate of lymph node metastasis of the primary lesion (p = 0.08) were higher or tended to be higher in patients with hepatic lymph node metastases than in those without. There was no significant relationship between the involvement of hepatic lymph nodes and the other clinicopathologic factors examined. CONCLUSION: We should note the frequency of hepatic lymph node metastasis in the treatment of unresectable liver metastases of colorectal cancer.     

A multifactorial analysis of prognostic factors in patients with liver metastases from colorectal carcinoma

A multifactorial analysis was used to identify the dominant prognostic variables predicting survival rates of 175 patients with hepatic metastases from colorectal carcinoma. Seven of 22 parameters examined simultaneously were found to independently influence the median survival rate in these patients: (1) elevated alkaline phosphatase (p = 0.0004), (2) elevated serum bilirubin level (p = 0.0005), (3) location of hepatic metastases (unilateral or bilateral, p = 0.0022), (4) number of metastatic nodes involved (0, 1-5, greater than 5; p = 0.0148), (5) depressed serum albumin (p = 0.0217), (6) whether or not the primary colorectal tumor was resected (p = 0.0013), and (7) chemotherapy (given or withheld, p = 0.0439). The prothrombin time, serum lactic dehydrogenase, and the number of hepatic metastases also correlated with survival, but they did not independently predict survival rates after other more dominant factors were accounted for. A mathematical equation for predicting an individual patient's clinical course once they developed hepatic metastases was derived from this statistical analysis. In addition, a simple and clinically useful guide for predicting outcome was developed that integrated the two most important risk factors, alkaline phosphatase and bilirubin.     

结直肠癌同时性肝转移患者行同期手术切除的预后分析

目的 探讨实施结直肠癌肝转移同期切除术患者的预后影响因素.方法 回顾性分析1993年1月至2003年1月间,在我院实施结直肠癌肝转移同期切除术且获得随访的44例患者的临床资料,应用Kaplan-Meier法进行生存分析,Log rank检验进行统计学比较,Cox比例风险模型进行多因素分析.结果 44例患者的1、3、5年生存率分别为86.3%、40.9%和25.0%.单因素分析显示,脉管瘤栓和区域淋巴结转移与患者术后生存有关;而性别、年龄、原发灶位置、肿瘤大体类型、分化程度、转移瘤数目以及转移瘤分布与术后生存无关.多因素分析显示,区域淋巴结转移是影响预后的独立危险因素.结论 对于结直肠癌同时性肝转移患者实施同期手术切除,可以获得较好的疗效,其中无淋巴结转移的患者疗效最佳.     

淋巴结阴性结肠癌伴同时性肝转移患者的临床病理因素分析*

目的：分析淋巴结阴性结肠癌患者发生同时性肝转移的危险因素,提高高危患者随访的效率和早诊率。方法：回顾性分析2008年1 月至2012年12月就诊北京肿瘤医院胃肠肿瘤中心并且行手术治疗的140 例淋巴结阴性结肠癌患者临床病理资料,通过单因素和多因素分析,研究淋巴结阴性结肠癌同期肝转移的高危因素。结果：140 例淋巴结阴性结肠癌患者同期肝转移13例（9.2%）,61.5%（8/ 13例）的患者伴有不全性结肠梗阻,6 例患者接受原发灶和肝转移灶同期手术治疗。单因素分析和多因素分析均提示脉管浸润（P = 0.010）和术前CEA 水平异常（P = 0.004）是淋巴结阴性结肠癌患者发生同时性肝转移的独立危险因素。结论：淋巴结阴性结肠癌存在较高的同时性肝转移风险,脉管浸润和术前CEA 水平异常是这类患者发生同期肝脏转移的高危因素,对具有该特征的患者在就诊时或根治术后应该针对性地检查肝脏情况,避免漏诊。     

结直肠癌伴肝转移91例患者的多因素预后分析

目的：探讨结直肠癌同时性肝转移患者的预后相关因素。方法：采用多因素回归分析方法回顾性分析了91例结直肠癌同时性肝转移患者的生存因素。结果：91例结直肠癌同时性肝转移的患者中位生存期为16.8个月,1年生存率为61.54%,3年生存率为14.79%,5年生存率为8.87%。单因素分析显示原发灶手术、肝转移分期、介入治疗、放射治疗、物理治疗、化疗和新药使用与患者的生存期显著相关;多因素分析显示,肝转移分期、原发病灶手术切除、介入治疗、物理治疗对患者的预后有显著影响,是结直肠癌同时性肝转移影响预后的主要因素。结论：对于结直肠癌同时性肝转移的患者应积极切除原发病灶,进行介入、物理等综合治疗可以提高患者的生存期。     

Potential predictors of survival after surgery for colorectal cancer patients with synchronous unresectable liver metastases

Liver resection has been recognized as the best treatment for patients with colorectal liver metastases, but as a curative resection for multiple and bilobar colorectal liver metastases (MBCLM) it is definitely less effective. We clarify predictors of survival for unresectable MBCLM. Potential predictors of overall survival, and the correlation between tumor marker and survival were evaluated for patients with synchronous unresectable MBCLM, including 6 rectal and 17 colon cancers. In univariate analysis, survival in patients with the following parameters were longer than those without them: number of liver metastases (10) and a >1.0 ratio of postoperative CEA/preoperative CEA were factors of poor prognosis, and patients with two such factors had an even worse prognosis. There was a tendency for correlation between the ratio of postoperative CEA/pre-operative CEA and survival (R=-0.492, P=0.053; y=17.388-3.733x). Thus, we clarified some of the predictors of survival for MBCLM, and the usefulness of serum CEA.     

乳腺癌肝转移的临床病程与预后分析

目的 探讨乳腺癌肝转移的临床病程、治疗效果及预后因素。方法 采用SPSS 11.5统计软件对152例乳腺癌肝转移患者的生存及预后因素进行回顾性分析。结果 全组中位无病生存期（DFS）为21个月,转移后中位生存期（MSR）为16个月,中位至疾病进展时间（TTP）为7．4个月。肝转移后一线化疗的有效率为54．5％,高于介入治疗（37．7％,P=0．039）。含紫杉类方案化疗组的有效率为63．3％,高于不含紫杉类方案化疗组（40．O％,P=0．04）;含紫杉类方案化疗组的TTP为10个月,亦高于不含紫杉类方案化疗组（7个月,P=0．048）。无论介入治疗（TACE）,还是化疗,治疗有效者的MSR（18个月）均长于无效者（14个月,P=0．002）。对于单发肝转移瘤患者,单纯介入治疗的MSR（30个月）长于单纯化疗（16个月,P=0．0052）;对于多发肝转移瘤患者,单纯介入治疗与单纯化疗的MSR差异无统计学意义。原发肿瘤大小、腋窝淋巴结转移数、雌激素受体状态、肝转移后转氨酶异常程度、肝转移灶大小是影响预后的重要因素。结论 有效的化疗（尤其是含紫杉类方案化疗）和介入治疗能明显改善乳腺癌肝转移患者的预后。     

Management of patients with asymptomatic colorectal cancer and synchronous irresectable metastases

BackgroundIn patients with asymptomatic colorectal cancer with irresectable metastatic disease, the optimal treatment strategy remains controversial. Resection of the primary tumor followed by chemotherapy when possible versus systemic chemotherapy followed by resection of the primary tumor when necessary are compared in this systematic review.Patients and methodsSeven studies reported series of patients with asymptomatic stage IV colorectal cancer and compared first-line chemotherapy with surgery for the primary tumor (n = 850 patients). Primary outcome measure was the complication rate related to the primary tumor in situ in patients receiving first-line systemic chemotherapy.ResultsWhen leaving the primary tumor in situ, the mean complications were intestinal obstruction in 13.9% [95% confidence interval (CI) 9.6% to 18.8%] and hemorrhage in only 3.0% (95% CI 0.95% to 6.0%) of the patients. After resection, the overall postoperative morbidity ranged from 18.8% to 47.0%.ConclusionsFor patients with stage IV colorectal cancer, resection of the asymptomatic primary tumor provides only minimal palliative benefit, can give rise to major morbidity and mortality and therefore potentially delays beneficial systemic chemotherapy. When presenting with asymptomatic disease, initial chemotherapy should be started and resection of the primary tumor should be reserved for the small portion of patients who develop major complications from the primary tumor.     

胃癌同时性肝转移预后的多因素分析

目的 胃癌肝转移预后差,且治疗策略亦未达成共识.本研究探讨影响胃癌肝转移预后的相关因素.方法 回顾性总结中山大学肿瘤防治中心2005-01-01-2010-12-31收治的有完整随访资料的胃癌同时性肝转移86例.选择年龄(X1)、性别(X2)、体质量减轻(X3)、血红蛋白(X4)、癌胚抗原(carcinoembryonic antigen,CEA;X5)、CA19-9(X6)、Borrmann分型(X7)、肿瘤部位(Xs)、肿瘤大小(X9)、肝转移程度(X10)、肝外转移(X11)、病理类型(X12)和综合治疗(X13)共13项临床病理参数作为观察指标.用Kaplan-Meier法绘制生存曲线,计算中位生存时间,用Log rank检验比较生存率,Cox回归风险比例模型行预后的多因素分析.结果 全组患者中位生存期221 d,1、3和5年生存率分别为31％、8％和3％.单因素分析表明,肿瘤大小、肝转移程度及综合治疗是影响胃癌肝转移预后的相关因素,P＜0.05;而多因素Cox回归模型显示,综合治疗是影响胃癌肝转移患者预后的独立因素,P＜0.05.结论 手术切除联合姑息化疗的综合治疗有助于改善胃癌同时性肝转移患者的预后.     

潜在可切除的结直肠癌同时性肝转移的治疗策略

肝转移是结直肠癌治疗的重点和难点,同时性肝转移接受根治性手术的机会更少,手术难度更大,因此预后更差。如何科学地判断肝转移灶的可切除性,有效地将潜在可切除肝转移灶转化为可切除病灶,对于治疗至关重要。本文就潜在可切除的结直肠癌同时性肝转移在临床治疗策略上的变革与发展进行综述。