射频消融治疗结直肠癌肝转移及其预后因素分析
Significance and prognostic factors in 84 patients with colorectal liver metastases treated with radiofrequency ablation
目的 分析射频消融(RFA)治疗结直肠癌肝转移的意义及预后影响因素.方法 回顾性研究2000年1月-2008年12月中山大学肿瘤防治中心接受RFA治疗的结直肠癌肝转移患者84例的临床及随访资料,生存状况,并对其观察影响远期因素进行多元统计分析.结果 84例患者共计265个瘤灶经BFA治疗后随访1-10年,所有患者的中位生存期为29个月,1、3、5年生存率分别为98%、27%、7%.对于肝内病变≤4 cm且数目≤3个的患者中位生存期为30个月,1、3、5年生存率分别为100%、31%、16%;>4 cm/>3个中位生存期为28个月,1、3、5年生存率分别96%、21%、0;RFA联合运用化学治疗的患者中位生存期为32个月,3、5年生存率分别为29%、8%,联合应用靶向药物治疗的患者的中位生存期达到41个月,3、5年生存率分别为60%、20%.多元分析的结果显示肝内病变数目及大小(P=0.004)、是否联合化疗药物(P=0.004)、化疗时机的选择(P=0.006)、是否合并有肝外转移(P=0.041)对患者远期生存率的影响差异均有统计学意义.结论 RFA治疗结直肠癌肝转移可以取得相对较好临床预后,肝脏肿瘤的大小和数目以及有无肝外转移是RFA治疗远期生存率的主要影响因素,应用化学药物特别是联合靶向药物治疗能有效改善患者的预后.
更多Objective To investigate the prognostic factors and significance of patients with colorectal liver metastases (CLM) treated with radiofrequency ablation(RFA).Methods A retrospective study wag conducted for the clinic outcomes, follow-up data and survival status in 84 patients with CLM undergoing RFA between January 2000 and December 2008.Univariate and multivariate analyses were performed by log-rank test and Cox's proportional hazard model respectively .Results A total of 265 lesions in 84 patients received RFA with a follow-up of 1-10 years. The median survival was 29 months,1-year survival rate 98%,3-year survival rate 27%and 5-year survival rate 7%.For those lesion≤4 cm and lesion number<3,the median survival time was 30 months,1-year survival rate 100%,3-year survival rate 31% and 5-year sunrival rate 16%.For those with lesions>4cm or lesion number>3,the median survival time was 28 months,1-year survival rate 96%,3-year survival rate 21%and 5-year survival rate 0.For those receiving RFA eombined with chemotherapy,the median survival time was 32 months,three-year survival rate 29% and five-year survival rate 8%.For those on molecular-target therapy,the median survival time was 41 months,3-year survival rate 60% and 5-year survival rate 20%.The multivariate statistical analysis showed that the influences of lesion number and size(P=0.004),chemotherapeutic agents and timing(P:0.004)and extra-liver metastases(P:0.097)had statistic significance to the survival rate.Conclusions RFA has a favorable outcome in the treatment of CLM patients.The prognostic factors of overall survival are correlated with the lesion size and presence or absence of extra-hepatic metastasis.It may effectively improve the patient prognosis by BFA in combination with chemotherapy and especially molecular-target therapy.
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