CAJ | 학술논문

目的：分析结直肠癌合并同时性肝转移患者的生存状况和相关影响因素。方法回顾性分析2000年至2010年复旦大学附属中山医院收治的1061例结直肠癌合并同时性肝转移患者的病例。收集所有患者的临床资料、病理特征、治疗策略、住院费用、随访状况等，进行生存状况分析，并采用单因素和Cox比例风险回归模型等分析影响结直肠癌肝转移生存的相关因素。结果肝转移灶可切除患者中，同期切除肠道原发灶和肝转移灶与分期切除患者的住院费用分别为25693元、34129元（ P＜0．05），手术并发症（分别为24．5％、20．5％）和总生存期方面（分别为48．5月、47．0月）无显著差异。肝转移灶不可切除且原发灶无症状的患者中，原发灶切除的患者总体中位生存时间明显好于原发灶未切除的患者（分别为19．0月、9．3月，P＜0．001）。肠道原发灶分化Ⅲ～Ⅳ级、肝转移灶≥4个、最大肝转移灶直径≥5 cm、肝外转移、肠道原发灶未手术切除和肝转移灶非手术治疗是影响肠癌同时性肝转移患者预后的独立危险因素。将上述6个危险因素各设定为1分，所有患者分为低风险组（0～1分）、中风险组（2～3分）和高风险组（4～6分），5年存活率分别为51％、16％和0％（ P＜0．001）。结论结直肠癌合并同时性肝转移患者中，原发灶和转移灶均可切除的可予以同期切除，原发灶可切除且无出血梗阻症状的不可切除的肝转移仍建议在合适时机切除肠道原发灶。根据上述6个独立预后因素所建立的预测模型可以指导临床采取合适的治疗方案。
목적：분석결직장암합병동시성간전이환자적생존상황화상관영향인소。방법회고성분석2000년지2010년복단대학부속중산의원수치적1061례결직장암합병동시성간전이환자적병례。수집소유환자적림상자료、병리특정、치료책략、주원비용、수방상황등，진행생존상황분석，병채용단인소화Cox비례풍험회귀모형등분석영향결직장암간전이생존적상관인소。결과간전이조가절제환자중，동기절제장도원발조화간전이조여분기절제환자적주원비용분별위25693원、34129원（ P＜0．05），수술병발증（분별위24．5％、20．5％）화총생존기방면（분별위48．5월、47．0월）무현저차이。간전이조불가절제차원발조무증상적환자중，원발조절제적환자총체중위생존시간명현호우원발조미절제적환자（분별위19．0월、9．3월，P＜0．001）。장도원발조분화Ⅲ～Ⅳ급、간전이조≥4개、최대간전이조직경≥5 cm、간외전이、장도원발조미수술절제화간전이조비수술치료시영향장암동시성간전이환자예후적독립위험인소。장상술6개위험인소각설정위1분，소유환자분위저풍험조（0～1분）、중풍험조（2～3분）화고풍험조（4～6분），5년존활솔분별위51％、16％화0％（ P＜0．001）。결론결직장암합병동시성간전이환자중，원발조화전이조균가절제적가여이동기절제，원발조가절제차무출혈경조증상적불가절제적간전이잉건의재합괄시궤절제장도원발조。근거상술6개독립예후인소소건립적예측모형가이지도림상채취합괄적치료방안。
Objective To conducte survival analysis of synchronous colorectal liver metastases (SCRLM).Methods Retrospectively collected clinicopathologic data of 1061 SCRLM patients,and then conducted univariate and Cox regression analyses .Results For patients with resectable SCRLM ,synchronous resection could reduce the expense compared with asynchronous resection , while there were no significant differences in short-term complications or long-term survival .For asymptomatic unresectable SCRLM patients,resection of primary tumor could improve long-term survival.Poor differentiation of primary tumor , number of liver metastases≥4, maximum liver metastasis≥5 cm, extra-liver metastases, no resection of primary tumor and no surgical treatment of liver metastases were independent prognosis factors .Giving one point to each above factor ,all SCRLM patients were divided into low-risk ( 0~1 ) , medium-risk ( 2~3 ) and high-risk(4~6)groups which 5-year-survival rates are 51%,16% and 0% respectively.Conclusions In patients with resectable SCRLM ,synchronous resection of primary tumor and liver metastases was the optimal choice.In asymptomatic patients with unresectable SCRLM ,resection of primary tumor was recommended at the right time.The prediction model should be used to guide clinical management of SCRLM patients .