射频消融治疗结直肠癌肝转移及其预后因素分析

目的 分析射频消融(RFA)治疗结直肠癌肝转移的意义及预后影响因素.方法 回顾性研究2000年1月-2008年12月中山大学肿瘤防治中心接受RFA治疗的结直肠癌肝转移患者84例的临床及随访资料,生存状况,并对其观察影响远期因素进行多元统计分析.结果 84例患者共计265个瘤灶经BFA治疗后随访1-10年,所有患者的中位生存期为29个月,1、3、5年生存率分别为98%、27%、7%.对于肝内病变≤4 cm且数目≤3个的患者中位生存期为30个月,1、3、5年生存率分别为100%、31%、16%;>4 cm/>3个中位生存期为28个月,1、3、5年生存率分别96%、21%、0;RFA联合运用化学治疗的患者中位生存期为32个月,3、5年生存率分别为29%、8%,联合应用靶向药物治疗的患者的中位生存期达到41个月,3、5年生存率分别为60%、20%.多元分析的结果显示肝内病变数目及大小(P=0.004)、是否联合化疗药物(P=0.004)、化疗时机的选择(P=0.006)、是否合并有肝外转移(P=0.041)对患者远期生存率的影响差异均有统计学意义.结论 RFA治疗结直肠癌肝转移可以取得相对较好临床预后,肝脏肿瘤的大小和数目以及有无肝外转移是RFA治疗远期生存率的主要影响因素,应用化学药物特别是联合靶向药物治疗能有效改善患者的预后.

Significance and prognostic factors in 84 patients with colorectal liver metastases treated with radiofrequency ablation

Objective To investigate the prognostic factors and significance of patients with colorectal liver metastases (CLM) treated with radiofrequency ablation(RFA).Methods A retrospective study wag conducted for the clinic outcomes, follow-up data and survival status in 84 patients with CLM undergoing RFA between January 2000 and December 2008.Univariate and multivariate analyses were performed by log-rank test and Cox's proportional hazard model respectively .Results A total of 265 lesions in 84 patients received RFA with a follow-up of 1-10 years. The median survival was 29 months,1-year survival rate 98%,3-year survival rate 27%and 5-year survival rate 7%.For those lesion≤4 cm and lesion number<3,the median survival time was 30 months,1-year survival rate 100%,3-year survival rate 31% and 5-year sunrival rate 16%.For those with lesions>4cm or lesion number>3,the median survival time was 28 months,1-year survival rate 96%,3-year survival rate 21%and 5-year survival rate 0.For those receiving RFA eombined with chemotherapy,the median survival time was 32 months,three-year survival rate 29% and five-year survival rate 8%.For those on molecular-target therapy,the median survival time was 41 months,3-year survival rate 60% and 5-year survival rate 20%.The multivariate statistical analysis showed that the influences of lesion number and size(P=0.004),chemotherapeutic agents and timing(P:0.004)and extra-liver metastases(P:0.097)had statistic significance to the survival rate.Conclusions RFA has a favorable outcome in the treatment of CLM patients.The prognostic factors of overall survival are correlated with the lesion size and presence or absence of extra-hepatic metastasis.It may effectively improve the patient prognosis by BFA in combination with chemotherapy and especially molecular-target therapy.