癌结节对结直肠癌肝转移同期切除术预后的影响

目的探讨癌结节对初始可切除同时性结直肠癌肝转移患者同期切除术预后的影响。 方法回顾性分析2003年7月至2015年7月复旦大学附属中山医院行同期切除的212例同时性结直肠癌肝转移患者资料，分析癌结节和临床病理因素的相关性，采用Kaplan-Meier生存分析和Cox回归模型分析癌结节对预后的影响。 结果癌结节的阳性率为43.9%（93/212），癌结节和肿瘤分化、淋巴结转移、血管浸润和神经浸润显著相关（P=0.044、0.001、0.035、<0.001），是低DFS的独立预后因素。癌结节阳性患者的OS和DFS明显低于癌结节阴性患者，差异有统计学意义（P=0.003、<0.001）。淋巴结阳性的135例患者中，癌结节阳性和阴性患者的OS比较，差异无统计学意义（P=0.608），癌结节阳性患者DFS更低（P=0.003）；在淋巴结阴性的77例患者中，癌结节阳性患者的OS和DFS均显著低于癌结节阴性患者（P<0.001、0.010）。 结论对于结直肠癌肝转移同期切除术后患者，癌结节和肿瘤分化、淋巴结转移以及神经浸润显著相关，且预示不良预后。

Tumor deposit as a poor prognostic indicator in patients undergoing simultaneous resection forinitially resectable colorectal liver metastases

ObjectiveTo determine the prognostic value of tumor deposits in initially resectable patients who underwent simultaneous resection for synchronous colorectal liver metastases (SCRLMs). MethodsBetween July 2003 and July 2015, clinicopathological and outcome data of two hundred and twelve consecutive SCRLMs patients who underwent simultaneous R0 resection were collected from SCRLMs database which was established prospectively. The prognostic value of tumor deposits was evaluated by Kaplan-Meier and Cox regression analysis. ResultsThe positive rate of tumor deposits was 43.9% (93/212). Tumor deposits were significantly correlated with tumor differentiation, lymph node metastasis, vascular invasion and nerve invasion of the primary tumors (P=0.044, 0.001, 0.035, <0.001, respectively). Kaplan-Meier survival analysis revealed that the overall survival (OS) and disease-free survival (DFS) of SCRLMs patients with positive tumor deposits were significantly poorer than those with negative tumor deposits (P=0.003, <0.001, respectively). And multivariate analysis showed that positive tumor deposits were significantly associated with shorter DFS independent of lymph node status (P<0.001). Subgroup analysis found that in the 135 patients with positive lymph node status, the OS of patients with tumor deposits was not significantly different from those without tumor deposits (P=0.608); however, tumor deposits were significantly correlated with shorter DFS (P=0.003). In the 77 SCRLMs patients with negative lymph node status, tumor deposits were significantly associated with shorter OS and DFS (P<0.001, 0.010, respectively). ConclusionTumor deposits may be an independent adverse prognostic factor for SCRLMs patients who underwent simultaneous R0 resection, which is significantly correlated with tumor differentiation, lymph node metastasis, vascular invasion and nerve infiltration.