摘要
目的探讨二次肝切除对结直肠癌肝转移（CRLM）术后早期复发患者预后的影响，并分析CRLM术后早期复发的危险因素。方法回顾性分析2000年1月至2014年8月间于北京肿瘤医院肝胆胰外一科行手术切除的303例CRLM患者的临床病理及随访资料。观察全组的生存情况，比较早期复发（1年内复发）和非早期复发患者的5年生存率，分析二次肝切除术对早期复发患者5年生存率的影响．并对可能影响患者早期复发的临床病理特征进行单因素和多因素分析。结果全组303例患者中，192例（63．4％）出现术后复发，其中早期复发145例、非早期复发47例，早期复发患者的5年生存率明显低于非早期复发者[16．0％比63．9％，P=0．000]。145例早期复发患者中，80例（55．2％）被再次评估为可切除，其中22例接受二次肝切除术患者的5年生存率明显高于非手术治疗的58例患者[27．1％比0，P=0．033]。多因素分析显示，原发灶浸润程度深（T3～T4）和淋巴结转移及肝转移灶大（大于5era）是CRLM早期复发的独立危险川素：而术前新辅助治疗有效（肿瘤完全缓解或部分缓解）是CRLM早期复发的独立保护性因素（均P〈0．05）。结论CRLM经手术切除后早期复发患者的预后较差．但复发后评估为可切除的患者接受二次肝切除术，能够显著延长生存时间。对于原发灶浸润程度深、淋巴结转移和肝转移灶大的患者．可考虑行积极的术前新辅助治疗。
Objective To explore the role of repeat liver resection in colorectal liver metastasis （CRLM） with early recurrence and to analyze the risk factors of early recurrence. Methods Clinicopathological and follow-up data of 303 CRLM patients undergoing liver resection in our department between January 2000 and August 2014 were analyzed retrospectively. The 5-year overall smvivals between early recurrence （within postoperative 1 year） and non-early recurrence were compared. The impact of repeat liver resection on 5-year survival of early recurrence was analyzed. Clinicopathological features which might he associated with early recurrence were investigated using univariate and muhivariate analyses. Results Among 303 patients, 192 （63.4%） patients had recurrence, including 145 patients of early recurrence and 47 of non-early reeurrenee. The 5-year overall survival of early recurrence patients was significantly lower compared with non-early recurrence ones （16.0% vs. 63.9%, P=0.000）. Among 145 early recurrence patients, 80 were evaluated as resectahle, of whom 22 received repeat liver resection. Compared with other 58 patients receiving conservative treatment, above 22 patients receiving repeat liver resection had a significantly higher 5-year overall survival （27.1% vs. 0%, P=0.033）. Multivariate analysis revealed T-stage of primary tumor, lymph node metastasis, and larger size（〉 5 cm） of metastatic liver focus were independent risk factors of early recurrence, and good efficacy of neo-adjuvant chemotherapy was independent protective factor of early recurrence（all P〈0.05）. Repeat liver resection was associated with better long-term survival. Conclusions The prognosis of early recurrence after liver resection in CRLM patients is poor, while repeat resection for resectable lesions in recurrence patients can obviously prolong the survival. For those with late T-stage, lymph node metastasis, and larger metastatic liver focus, actively preoperative neo-adjuvant chemotherapy should be considered.
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2015年第11期1098-1101,共4页
Chinese Journal of Gastrointestinal Surgery
基金
国家自然科学基金（81371868）
关键词
结直肠肿瘤
肝转移
肝切除术
复发
危险因素
Colorectal neoplasms
Liver metastases
Liver resection
Recurrence
Risk factor
