论文部分内容阅读
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。
BACKGROUND & OBJECTIVE: Colorectal cancer is one of the most common tumors in China. The incidence of liver metastasis in colorectal cancer can reach 10% ~ 25% at the same time. This article explores the factors affecting the prognosis of patients with concurrent liver metastases and the choice of treatment. Methods: A retrospective analysis of 220 cases of newly diagnosed colorectal cancer patients with liver metastasis from December 1995 to December 2002 in Sun Yat-sen University Cancer Center was conducted. The clinical data were analyzed statistically. Univariate analysis of the prognosis of patients with concurrent liver metastases from colorectal cancer by Kaplan-Meier method and multivariate analysis using Cox model. Results: The 5-year survival rate was 5.52% and the median survival time was 12.93 months. Kaplan-Meier and log-rank analysis of clinical characteristics of one-way survival analysis, statistically significant variables include: the number of liver metastases, maximum diameter of liver metastases, distribution of liver metastases, extrahepatic invasion or metastasis , When diagnosed CEA levels, local lymph node metastasis, pathological type. The single factor survival analysis of clinical treatment, statistically significant variables include: treatment, complete resection of the primary tumor and the choice of chemotherapy. Multivariate analysis using Cox model found that liver metastases distribution of liver lobes, the maximum diameter of liver metastases, extrahepatic invasion or metastasis, the diagnosis of CEA levels, treatment modalities, primary lesions were removed, the chemotherapy regimens were independent The prognostic risk factors. CONCLUSIONS: For patients with simultaneous liver metastases of colorectal cancer, the maximum diameter of liver metastases exceeds 5 cm and the distribution of liver metastases exceeds one leaf. The presence of extrahepatic invasion or metastases and the CEA level of more than 200 μg / L suggest that patients have poor prognosis. For patients with colorectal cancer only liver metastases should be as much as possible, radical surgery of the primary tumor and metastasis, for the treatment of unresectable liver metastases can be considered underwent systemic chemotherapy and / or interventional therapy, systemic chemotherapy is the best selection with oxaliplatin Program.