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结直肠癌肝转移患者外科切除疗效分析

Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer-a multifactorial model of 191 patients

摘要:

目的 探讨影响结直肠癌肝转移外科手术后疗效的风险因素.方法 回顾性分析2000年1月至2012年8月行肝切除手术治疗的191例结直肠癌肝转移患者的临床资料,采用Kaplan-Meier法计算生存率,Log-rank法分析患者生存情况,对各种影响预后的因素分别进行单因素和多因素Cox回归分析.结果 全组患者术后中位生存期33.0个月,5年生存率为38.4%;无病中位生存期10.0个月,5年无病生存率为23.6%.同时性肝转移患者的中位生存期(26.0个月)及5年生存率(27.4%)显著低于异时性肝转移患者(Z=-1.285,x2=6.527,P<0.05).对于总生存期,单因素分析结果显示,性别(x2=5.219)、原发灶N分期(x2 =5.591)、肝转移灶分布(x2=4.269)、肝转移灶数目(x2=5.051)、肝转移灶出现时间(x2=6.527)、肝切除术前癌胚抗原(CEA)水平(x2=4.454)及是否存在肝外转移灶(x2=5.158)是影响预后的因素(P< 0.05).Cox多因素分析结果显示,原发灶N分期(RR=2.198,95%CI:1.146 ~4.216)、肝转移灶出现时间(RR=1.840,95% CI:1.139 ~2.973)和肝切除术前CEA水平(RR=1.854,95%CI:1.056~3.255)是影响预后的独立危险因素.结论 外科手术切除可以使结直肠癌患者获得长期生存,肝转移灶出现时间、原发灶N分期和肝切除术前CEA水平是影响预后的独立危险因素.

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abstracts:

Objective To identify risk factors associated with overall survival (OS) for patients undergoing primary hepatic resection for metastatic colorectal cancer.Methods The clinical and pathological data were prospectively collected from 191 consecutive patients undergoing primary hepatic resection for colorectal liver metastases from January 2000 to August 2012.The survival curve was drawn by Kaplan-Meier method,and the survival rates were analyzed by Log-rank test.Parametric survival analysis was used to identify predictors of cancer-specific survival.Results The 5-year overall survival were 38.4% and median survival time was 33 months; 5-year disease-free survival were 23.6%,and the median diseasefree survival time was 10.0 months.5-years survival rate was significantly lower in patients with synchronal metastasis than in patients with heterochronia metastasis (27.4% vs.51.8%,x2 =6.527,P <0.05).In overall survival,univariate analysis found 7 risk factors:gender (x2 =5.219),N stage of the primary tumor (x2 =5.591),bilobar metastases (x2 =4.269),number of metastases ≥ 2 (x2 =5.051),disease-free interval ≥ 6 months (x2 =6.527),carcinoembyonic antigen level ≥ 30 μg/L (x2 =4.454),and extrahepatic disease (x2 =5.158).On multivariate analysis,3 risk factors were found to be independent predictors of poor survival:N stage of the primary tumor (RR =2.198,95% CI:1.146-4.216),disease-free interval ≥ 6 months (RR =1.840,95% CI:1.139-2.973),carcinoembyonic antigen level ≥30 μg/L(RR =1.854,95% CI:1.056-3.255).Conclusions Resection of liver metastases provides good long-term cancer-specific survival benefit.N stage of the primary tumor,disease-free interval,carcinoembyonic antigen level are important prognostic factors for colorectal liver metastasis.

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作者: 姜庆龙 [1] 闫晓峦 [1] 王崑 [1] 包全 [1] 孙谊 [1] 王宏伟 [1] 金克敏 [1] 邢宝才 [1]
第一作者: 姜庆龙
期刊: 《中华外科杂志》2014年52卷3期 171-174页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2014.03.004
发布时间: 2014-04-01
基金项目:
国家自然科学基金资助项目
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