CAJ | 학술논문

目的探讨结直肠癌肝转移术后复发的影响因素及不同复发状态对生存的影响.方法回顾性分析北京大学肿瘤医院肝胆外一科结直肠癌肝转移手术切除病例术后复发/转移的影响因素及复发状态对于预后的影响.结果自2000年1月至2013年4月结直肠癌肝转移手术切除术后出现复发转移患者152例.全组中位总生存期(OS) 28.9个月,5年生存率22.1％;全组中位无病生存期(DFS) 7.6个月;早期复发/转移组(术后6个月内,n=60)中位生存时间19.4个月,非早期复发组(n=92)中位生存35.1个月(P =0.000);不同复发/转移的器官累及状态对于生存差异无统计学意义,复发转移后手术切除能够改善预后;多因素分析显示,原发病灶的淋巴结转移及肝转移灶的数目是影响复发/转移的独立危险因素;术前新辅助治疗有效(CR+ PR)是影响复发的独立保护性因素.结论原发病灶的淋巴结转移、肝转移个数,新辅助治疗的疗效是影响结直肠癌肝转移术后复发的主要因素.肝转移复发后的再切除能够改善患者预后.
목적 탐토결직장암간전이술후복발적영향인소급불동복발상태대생존적영향.방법 회고성분석북경대학종류의원간담외일과결직장암간전이수술절제병례술후복발/전이적영향인소급복발상태대우예후적영향.결과 자2000년1월지2013년4월결직장암간전이수술절제술후출현복발전이환자152례.전조중위총생존기(OS) 28.9개월,5년생존솔22.1％;전조중위무병생존기(DFS) 7.6개월;조기복발/전이조(술후6개월내,n=60)중위생존시간19.4개월,비조기복발조(n=92)중위생존35.1개월(P =0.000);불동복발/전이적기관루급상태대우생존차이무통계학의의,복발전이후수술절제능구개선예후;다인소분석현시,원발병조적림파결전이급간전이조적수목시영향복발/전이적독립위험인소;술전신보조치료유효(CR+ PR)시영향복발적독립보호성인소.결론 원발병조적림파결전이、간전이개수,신보조치료적료효시영향결직장암간전이술후복발적주요인소.간전이복발후적재절제능구개선환자예후.
Objective To explore the outcomes of different recurrence patterns and recurrencerelated factors after hepatectomy in patients with colorectal liver metastases (CRLM).Methods The outcomes of different recurrence patterns and recurrence-related factors for surgical resection of CRLMs was reviewed retrospectively.Results A total of 152 postoperative recurrent cases were included between 2000 and 2013.The median overall survival was 28.9 months and 5-year survival 22.1％ for the entire group.The median disease-free survival was 7.6 months.Among them,60 patients had disease recurrence within 6 months after hepatectomy (early recurrence) and their median overall survival was 19.4 months versus 35.1 months (n =92) for those with a disease-free interval of over 6 months (P =0.000).Repeat resection was associated with better outcomes,but different patterns of recurrence were not.Lymph node metastases of primary tumor,number of metastases and efficacy of neo-adjuvant chemotherapy (NACT) were independently associated with recurrence.Conclusions Recurrence after hepatectomy of CRLMs is affected by lymph node metastases of primary tumor,number of metastases and efficacy of NACT.Additional survival advantage may be achieved by resection of recurrent disease.