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目的:探讨影响结直肠癌伴肝转移患者预后的临床病理因素。方法:回顾分析1998年1月至2003年1月中国医科大学附属第一医院和沈阳医学院沈洲医院收治的92例结直肠癌伴肝转移患者的临床资料。并应用Cox回归模型分析影响预后的因素,建立预后指数(prognostic index,PI)方程,并根据PI值将患者分为高危组、中危组和低危组,比较各组的生存率并绘制生存曲线。结果:单因素分析显示肿瘤细胞分化程度、原发肿瘤切除与否、肝转移灶切除与否、肝转移灶的数目和术前癌胚抗原(carcino-embryonic antigen,CEA)水平(μg/L)5个因素对预后有影响,差异有统计学意义(P<0.05)。多因素分析显示肝脏转移灶切除与否、肝脏转移灶的数目和术前CEA水平(μg/L)是3个独立的预后因素。3组生存率差异有统计学意义(P<0.05)。结论:结直肠癌肝转移的患者应积极切除原发病灶,对于肝转移灶可切除的应同期切除。PI值可用于结直肠癌肝转移患者的预后估计,可为临床进行分层的个体化治疗提供参考。
Objective: To investigate the clinicopathological factors affecting the prognosis of colorectal cancer with liver metastasis. Methods: The clinical data of 92 patients with colorectal cancer with liver metastasis admitted from the First Affiliated Hospital of China Medical University and Shenzhou Hospital of Shenyang Medical College from January 1998 to January 2003 were retrospectively analyzed. Cox regression model was used to analyze the prognostic factors, and the prognostic index (PI) equation was established. According to PI, the patients were divided into high-risk group, moderate-risk group and low-risk group. curve. Results: Univariate analysis showed the degree of tumor cell differentiation, primary tumor resection or not, resection of liver metastases, number of liver metastases and preoperative carcinoembryonic antigen (CEA) level (μg / L) Five factors have an impact on the prognosis, the difference was statistically significant (P <0.05). Multivariate analysis showed that resection of the liver metastases, liver metastases and the number of preoperative CEA levels (μg / L) are three independent prognostic factors. There was significant difference in survival rate between the three groups (P <0.05). Conclusion: Patients with liver metastases of colorectal cancer should be actively resected primary lesions, resectable for liver metastases should be resected simultaneously. The PI value can be used to estimate the prognosis of patients with liver metastasis of colorectal cancer, which can provide a reference for the individual clinical treatment of stratification.