多发性结直肠癌肝转移肝切除的生存状况及预后影响因素分析

摘要

目的：探讨多发性结直肠癌患者肝转移肝切除后的生存状况及预后影响因素。方法回顾性分析2006年2月至2014年2月收治的48例多发性结直肠癌肝转移（病灶数≥4个）接受肝切除术患者的临床及随访资料。统计患者的生存状况，采用Kaplan-Meier法计算累积生存率，单因素分析采用Log-rank检验，多因素分析采用COX回归模型。结果48例无围手术期死亡，术后并发症发生率为35.4%，术后中位生存期为34.5个月，1、2、3、5年累积生存率分别为88.7%、64.4%、46.5%、27.9%；中位无病生存时间为7.1个月，1、2年累积无病生存率分别为33.8%、14.1%。单因素分析结果显示：原发癌T分期、肝转移灶数目、转移灶最大直径、是否行新辅助治疗、肝转移切除范围、肝转移复发是否再次切除是多发性结直肠癌肝转移肝切除患者预后的影响因素（ P <0.05）。多因素分析结果显示：肝转移灶数目（ OR=3.483，95%CI 1.492~7.021，P =0.001）和肝转移切除范围（ OR=2.994，95%CI 1.093~6.372，P =0.002）是预后的独立影响因素。结论对于超过4个转移灶的结直肠癌肝转移患者，手术切除甚至复发后再次切除仍可以使患者生存获益，肝转移灶数和肝切除范围是的预后的主要影响因素。%Objective To explore the survival conditions and factors affecting prognosis in patients multiple liver metastasis after liver re-section with colorectal cancer. Methods Retrospectively analysis was performed in the clinical and follow-up data of 48 cases of patients with multiple colorectal liver metastases(lesion number≥4)who received liver resection from February 2006 to February 2014. Statistics analysis was performed in the survival condition of patients,using the Kaplan-Meier method to calculate the cumulative survival rate,the single factor analysis of prognosis influencing factors using the Log-rank test,multiple-factor analysis using COX regression model. Results There is no periopera-tive death cases in 48 patients. The incidence of postoperative complications was 35. 4%. The postoperative median survival was 34. 5 months. The 1,2,3,5 years accumulated OS rate respectively was 88. 7%,64. 4%,46. 5% and 27. 9%. Median DFS was 7. 1 months. The 1,2 years accumulated DFS rate respectively was 33. 8%,14. 1%. The results of the single factor analysis show that the T staging of the primary cancer, number of liver metastases,maximum diameter of metastases,whether receiving neoadjuvant therapy,the scope of the liver resection,liver meta-static recurrence repeated resection are the influence factors of the prognosis of patients with multiple colorectal liver metastases treated by liver re-section( P <0. 05). The results of the multi-factor analysis show that the number of liver metastases(OR=3. 483,95% CI 1. 492~7. 021, P =0. 001)and the scope of the liver resection(OR=2. 994,95% CI 1. 093~6. 372,P =0. 002)were independent influence factors of the prognosis. Conclusion Patients with multiple colorectal liver metastases can still receive survival benefit from surgical resection or repeated resec-tion after recurrence. The number of liver metastases and the scope of the liver resection are the main influencing factors of the prognosis.