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。

Prognostic analysis of 220 colorectal cancer patients with synchronous liver metastases

BACKGROUND & OBJECTIVE: Colorectal cancer is one of the most common malignant tumors in China. Synchronous liver metastases occur in 10%-25% colorectal cancer patients. This study was to elucidate the prognostic factors and treatment choices for colorectal cancer patients with synchronous liver metastases. METHODS: Records of 220 colorectal cancer patients with synchronous liver metastases initially treated at Cancer Center of Sun Yat-sen University from Dec. 1995 to Dec. 2002 were reviewed. Prognostic factors were analyzed by Kaplan-Meier method and Cox regression model with SPSS12.0 software. RESULTS: The 5-year overall survival rate was 5.52%, the median survival time of the patients was 12.93 months. Univariate analysis of clinical characteristics revealed that the number, size and distribution of liver metastases, extrahepatic disease, serum CEA level at diagnosis, N status, and histology were prognostic factors. Univariate analysis of clinical treatment factors showed that treatment modality, primary site resection, and chemotherapy regimen were prognostic factors. Multivariate analysis showed that the number and size of liver metastases, extrahepatic disease, serum CEA value at diagnosis, treatment modality, primary tumor resection, and chemotherapy regimen were independent prognostic factors of colorectal cancer patients with synchronous liver metastases. CONCLUSIONS: Liver metastases larger than 5 cm in diameter, bilobar liver metastases, extrahepatic invasion or metastases, and CEA level more than 200 microg/L at diagnosis are adverse prognostic factors. Primary tumor resection and liver resection should be considered for all suitable patients with colorectal metastases to the liver alone. Liver-target intervention and/or systemic chemotherapy might be a good choice for inoperable patients. If possible, systemic chemotherapy containing oxaliplatin is preferred.