CAJ | 학술논문

目的探讨影响结直肠癌肝转移外科手术后疗效的风险因素.方法回顾性分析2000年1月至2012年8月行肝切除手术治疗的191例结直肠癌肝转移患者的临床资料,采用Kaplan-Meier法计算生存率,Log-rank法分析患者生存情况,对各种影响预后的因素分别进行单因素和多因素Cox回归分析.结果全组患者术后中位生存期33.0个月,5年生存率为38.4％；无病中位生存期10.0个月,5年无病生存率为23.6％.同时性肝转移患者的中位生存期(26.0个月)及5年生存率(27.4％)显著低于异时性肝转移患者(Z=-1.285,x2=6.527,P＜0.05).对于总生存期,单因素分析结果显示,性别(x2=5.219)、原发灶N分期(x2 =5.591)、肝转移灶分布(x2=4.269)、肝转移灶数目(x2=5.051)、肝转移灶出现时间(x2=6.527)、肝切除术前癌胚抗原(CEA)水平(x2=4.454)及是否存在肝外转移灶(x2=5.158)是影响预后的因素(P＜ 0.05).Cox多因素分析结果显示,原发灶N分期(RR=2.198,95％CI:1.146 ～4.216)、肝转移灶出现时间(RR=1.840,95％ CI:1.139 ～2.973)和肝切除术前CEA水平(RR=1.854,95％CI:1.056～3.255)是影响预后的独立危险因素.结论外科手术切除可以使结直肠癌患者获得长期生存,肝转移灶出现时间、原发灶N分期和肝切除术前CEA水平是影响预后的独立危险因素.
목적 탐토영향결직장암간전이외과수술후료효적풍험인소.방법 회고성분석2000년1월지2012년8월행간절제수술치료적191례결직장암간전이환자적림상자료,채용Kaplan-Meier법계산생존솔,Log-rank법분석환자생존정황,대각충영향예후적인소분별진행단인소화다인소Cox회귀분석.결과 전조환자술후중위생존기33.0개월,5년생존솔위38.4％；무병중위생존기10.0개월,5년무병생존솔위23.6％.동시성간전이환자적중위생존기(26.0개월)급5년생존솔(27.4％)현저저우이시성간전이환자(Z=-1.285,x2=6.527,P＜0.05).대우총생존기,단인소분석결과현시,성별(x2=5.219)、원발조N분기(x2 =5.591)、간전이조분포(x2=4.269)、간전이조수목(x2=5.051)、간전이조출현시간(x2=6.527)、간절제술전암배항원(CEA)수평(x2=4.454)급시부존재간외전이조(x2=5.158)시영향예후적인소(P＜ 0.05).Cox다인소분석결과현시,원발조N분기(RR=2.198,95％CI:1.146 ～4.216)、간전이조출현시간(RR=1.840,95％ CI:1.139 ～2.973)화간절제술전CEA수평(RR=1.854,95％CI:1.056～3.255)시영향예후적독립위험인소.결론 외과수술절제가이사결직장암환자획득장기생존,간전이조출현시간、원발조N분기화간절제술전CEA수평시영향예후적독립위험인소.
Objective To identify risk factors associated with overall survival (OS) for patients undergoing primary hepatic resection for metastatic colorectal cancer.Methods The clinical and pathological data were prospectively collected from 191 consecutive patients undergoing primary hepatic resection for colorectal liver metastases from January 2000 to August 2012.The survival curve was drawn by Kaplan-Meier method,and the survival rates were analyzed by Log-rank test.Parametric survival analysis was used to identify predictors of cancer-specific survival.Results The 5-year overall survival were 38.4％ and median survival time was 33 months; 5-year disease-free survival were 23.6％,and the median diseasefree survival time was 10.0 months.5-years survival rate was significantly lower in patients with synchronal metastasis than in patients with heterochronia metastasis (27.4％ vs.51.8％,x2 =6.527,P ＜0.05).In overall survival,univariate analysis found 7 risk factors:gender (x2 =5.219),N stage of the primary tumor (x2 =5.591),bilobar metastases (x2 =4.269),number of metastases ≥ 2 (x2 =5.051),disease-free interval ≥ 6 months (x2 =6.527),carcinoembyonic antigen level ≥ 30 μg/L (x2 =4.454),and extrahepatic disease (x2 =5.158).On multivariate analysis,3 risk factors were found to be independent predictors of poor survival:N stage of the primary tumor (RR =2.198,95％ CI:1.146-4.216),disease-free interval ≥ 6 months (RR =1.840,95％ CI:1.139-2.973),carcinoembyonic antigen level ≥30 μg/L(RR =1.854,95％ CI:1.056-3.255).Conclusions Resection of liver metastases provides good long-term cancer-specific survival benefit.N stage of the primary tumor,disease-free interval,carcinoembyonic antigen level are important prognostic factors for colorectal liver metastasis.