异时性结直肠癌肝转移新辅助化疗对手术疗效的临床价值

摘要

Objective To explore the efficacy of neoadjuvant chemotherapy for patients with meta-chronous colorectal carcinoma liver metastases (CLM)and explore its potential influencing factors.Methods A total of 82 CLM patients were recruited.And their clinical and follow-up data were analyzed retrospec-tively.Survival analysis and comparison were conducted between neoadjuvant chemotherapy and surgery a-lone groups.Results All candidates underwent radical resection and 1,3 and 5-year survival rates were 100%,80% and 13% respectively.And 27 patients received neoadjuvant chemotherapy with FOLFOX regi-men while the remainder was operated directly.No difference on survival was detected.The surgery alone group fared better than neoadjuvant chemotherapy group in preoperative alaninine aminotransferase (ALT)& aspartate aminotransferase (AST),operative duration,transfusion rate and postoperative complications. Poor prognostic factors included poor differentiation tumor,>6 cycles of neoadjuvant chemotherapy,carci-noembryonic antigen (CEA)>200 μg/L,CRS>2 and liver metastasis within 1 year.Conclusions Resect-able metachronous CLM may not benefit from neoadjuvant chemotherapy but may increase postoperative complications.Neoadjuvant chemotherapy is not recommended.And tumor differentiation is an independent influencing factor for survival.%目的：探讨异时性结直肠癌肝转移(colorectal cancer liver metastasis,CLM)病人术前新辅助化疗对预后的影响,分析手术切除治疗的预后影响因素。方法回顾2007年3月至2010年2月82例手术切除治疗 CLM 病人的临床资料和随访信息,进行生存分析并比较新辅助化疗与否对手术、预后的影响。结果全组病人均根治性切除,1、3、5年总生存率100%、80%、13%,FOLFOX 新辅助化疗27例,直接手术55例,两组比较总生存期差异无统计学意义(P =0.192),直接手术组术前丙氨酸转氨酶、天冬氨酸转氨酶水平较新辅助化疗组低,直接手术组手术时间更短、术中输血率、术后并发症均低于新辅助化疗组。预后不良因素包括肿瘤低分化、6次以上新辅助化疗、癌胚抗原>200μg/L、危险度评分>2分、原发瘤术后1年以内的肝转移。结论可切除异时性 CLM 病人可能无法从术前新辅助化疗中生存获益,并有增加手术并发症的风险,行新辅助化疗应慎重。肿瘤分化程度是影响预后的独立因素。