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.

The Analysis of Prognostic Factors for Liver Metastasis from Colorectal Cancer

Objective:To explore the prognostic factors that influence the survival rate of patients with liver metastasis from colorectal cancer and analyze the significance of the these factors.Methods: Clinical and pathological data of 158 patients with liver metastasis from colorectal cancer were collected in this study.Univariate and multivariate analysis of 12 factors was used to determine the prognostic factors.Results:In these cases,radical resection,palliative resection and explorative operation/best supportive care were carried out in 67 patients(42.4%),53 patients(33.5%),and 38 patients(24.1%),respectively.Eighty-two patients(51.9%)received systemic chemotherapy after surgical resection and 76 patients(48.1%)did not.The positive and negative pathological margins were correlated with each other in 132 cases(83.5%)and 26 cases(16.5%),respectively.The median overall survival was 41 months and the 5-year survival rate was 27%.Univariate analysis showed that the surgical treatment(P=0.013<0.05),N stage of the primary disease(P=0.003<0.05),secondary treatment (P=0.041<0.05),the size and distribution of the liver metastatic focus(P=0.037<0.05 and P=0.032<0.05),and the pathological margin(P=0.000<0.001)were predictors of survival.Regional lymph node metastatic status was a significant prognostic factor according to the multivariate analysis(P=0.004). Conclusion:Radical resection of hepatic metastases from colorectal cancer is considered the only effective therapy for long-term survival.Candidates for one-stage radical hepatic resection must be selected appropriately.Neoadjuvant chemotherapy should be followed by radical resection for patients deemed unfit in order to improve the success rate of radical resection and long-term survival.