无法治愈的晚期结直肠癌肝转移患者的临床病理特征与姑息性治疗预后的生存分析

目的：通过分析无法治愈的晚期结直肠癌肝转移患者临床病理特征与姑息性治疗预后的相互关系，探讨姑息性治疗对患者预后生存的影响。方法：回顾性分析第二军医大学东方肝胆外科医院自2009年1月至2009年12月收治的82例无法治愈的晚期结直肠癌肝转移患者临床资料。采用 Kaplan －Meier 法计算生存率及生存曲线，并进行单因素分析，采用 Log －rank 进行统计学检验。经单因素分析对预后有统计学意义的危险因素带入 COX 多因素回归模型，计算独立预后因素。结果：总体中位生存期为19．09个月，1、2、3年累计生存率分别为82％、28％、13％；对经过严格筛选，评估原发病灶与肝内转移灶可以完整切除而肝外不可切除的转移灶未予以手术处理但生长局限，术中发现肿瘤侵犯周围组织、器官仍可局部切除，且具备强烈手术意愿的晚期结直肠癌肝转移患者实施姑息性手术切除，术后中位生存期、1年、2年累计生存率均显著优于非手术治疗者：27．00个月 vs 16．36个月，85％ vs 79％，57％ vs 0（P ＜0．001）。对于总体生存期而言，单因素分析显示：不同的治疗方式、肝转移瘤生长位置、肝内转移灶数目为影响患者预后的因素（P ＜0．05）；COX 多因素分析结果显示：非手术治疗方式、肝内转移灶多发是对无法治愈的晚期结直肠癌肝转移患者姑息性治疗预后产生影响的独立危险因素。结论：对于经过严格筛选，评估原发病灶与肝内转移灶可以完整切除而肝外不可切除的转移灶未予以手术处理但生长局限，术中发现肿瘤侵犯周围组织、器官仍可局部切除且具备强烈手术意愿的结直肠癌肝转移患者，接受姑息性手术治疗，其生存优于非手术治疗患者。

Correlation between the clinicopathological features of patients with CRLMwho cannot be cured and their posttreatment survival

Objective:Analyzing the correlation between the clinicopathological features of patients with CRLM who cannot be cured and their palliative posttreatment survival.Methods:The clinical data of 82 patients with CRLM who had received different palliative treatments at the Eastern Hepatobiliary Hospital of the Second Military Medical University from January 2009 to December 2009 were retrospectively investigated,and their clinicopathological fea-tures,as well as their prognosis,were analyzed.The survival curve was drawn by Kaplan -Meier method,and the sur-vival rates were analyzed by Log -rank test.Parametric survival analysis was used to identify predictors of cancer -specific survival.Results:The median survival time of posttreatment was 19.09 months,with cumulative 1 -year,2 -year,and 3 -year survival rates of 82%,28%,and 13%,respectively.The median survival time,with cumulative 1 -year and 2 -year survival rates of patients with palliative operations after cancer resection was better than patients with non -operations:27.00 months vs 16.36 months,85% vs 79%,57% vs 0(P <0.001),respectively.In overall survival,the results of univariate analysis showed that 3 factors,including treatment method,the number of liver metas-tases,the position of the liver metastases,were closely related to the clinicopathological features associated with prog-nosis and the differences were statistically significant(P <0.05).The results of multivariate survival analysis demon-strated that received non -operations,the number of liver metastases appeared as multiple and wide distribution,were the independent risk factors affecting the posttreatment survival of the patients with CRLMwho were certain contrain-dicated for operations(P <0.05).Conclusion:The survival of patients who were strictly selected before treatment,re-minded that the primary and secondary cancer could be completely removed,other unresectable extrahepatic metasta-ses were unremoval but localized growth,invasion in blood vessels or the surrounding tissue could be local resected, and had a strong desire for operation,received palliative operations after cancer resection was better than patients with non -operations,while they all cannot be cured.