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.

Analysis of prognostic factors in 300 colorectal cancer patients with liver metastases

Objective To analyse the clinical characteristics and potential prognostic factors of colorectal cancer patients with liver metastases. Methods The clinical and pathological data of 300 colorectal cancer patients with liver metastases were retrospectively reviewed and annalyzed. Results The median survival time of these patients was 19.0 months. The 1-, 2-and 5-year survival rates after liver metastases were 79.0%, 29.0% and 3.0%, respectively. Univariate analysis revealed that performance status (KPS), histological grading, primary tumor, N status, lymphatic and vascular invasion, stage at diagnosis, the number, size and distribution of liver metastases and other accompanied metastases were prognostic factors. Multivariate analysis showed that KPS, lymphatic and vascular invasion, the number and size of liver metastases were independent prognostic factors of colorectal cancer with liver metastases. Conclusion Performance status, lymphatic and vascular invasion, the number and size of liver metastases are independent prognostic factors of colorectal cancer with liver metastases.