CAJ | 학술논문

目的分析影响结直肠癌肝转移患者根治性手术切除预后的临床病理因素,探讨改善患者预后的方法.方法收集2005年1月至201 1年12月江苏省苏北人民医院和复旦大学附属肿瘤医院收治的103例结直肠癌肝转移根治性切除患者的临床资料.采用Kaplan-Meier法计算生存率,用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变量和多变量Cox回归分析.结果 103例患者均获随访,随访时间10～ 60个月,术后1、3、5年生存率分别为90％、49％、39％.单因素分析结果显示:肝转移灶数目、大小、分布、术前CEA水平、手术并发症、术后化疗是肝转移灶切除术后的影响因素(x2值分别为24.732、9.461、9.568、25.948、25.370、5.701,P＜0.05)；多因素分析显示,肝转移灶数目、肝转移灶切除术前CEA水平、手术并发症是影响预后的独立因素(Wald=7.974、12.051、11.547,P＜0.05).结论肝转移灶数目、肝转移灶切除术前CEA水平和手术并发症是影响结直肠癌肝转移患者预后的独立因素.适当扩大手术切除的适应证,加强对高危患者的随访和术后辅助化疗,可能改善肝转移患者的预后.
목적 분석영향결직장암간전이환자근치성수술절제예후적림상병리인소,탐토개선환자예후적방법.방법 수집2005년1월지201 1년12월강소성소북인민의원화복단대학부속종류의원수치적103례결직장암간전이근치성절제환자적림상자료.채용Kaplan-Meier법계산생존솔,용Log-rank법분석환자생존정황,대각충영향예후적인소분별진행단변량화다변량Cox회귀분석.결과 103례환자균획수방,수방시간10～ 60개월,술후1、3、5년생존솔분별위90％、49％、39％.단인소분석결과현시:간전이조수목、대소、분포、술전CEA수평、수술병발증、술후화료시간전이조절제술후적영향인소(x2치분별위24.732、9.461、9.568、25.948、25.370、5.701,P＜0.05)；다인소분석현시,간전이조수목、간전이조절제술전CEA수평、수술병발증시영향예후적독립인소(Wald=7.974、12.051、11.547,P＜0.05).결론 간전이조수목、간전이조절제술전CEA수평화수술병발증시영향결직장암간전이환자예후적독립인소.괄당확대수술절제적괄응증,가강대고위환자적수방화술후보조화료,가능개선간전이환자적예후.
Objective To analyze the clinicopathological factors impacting on the prognosis of colorectal cancer liver metastases and to investigate how to improve patients' survival.Methods The clinical data of 103 patients who received radical resection for liver metastases from colorectal cancer from January 2005 to December 2011 were enrolled.The survival curve was drawn by Kaplan-Meier method,and the survival rates were analyzed by Log-rank test.Factors influencing survival were analyzed by Cox regression model.Results All patients were followed up from 10 to 60 months,The 1-,3-,5-year's survival rates were 90％,49％,39％,respectively.Univariate analysis revealed that number and size of liver metastases,distribution of liver metastases,serum CEA concentration,complications,postoperative chemotherapy were related to prognosis (x2 =24.732,9.461,9.568,25.948,25.370,5.701,P ＜ 0.05).Multivariate analysis identified number of liver metastases,serum CEA concentration,complications were as significant predictors of survival (Wald =7.974,12.051,11.547,P ＜ 0.05).Conclusions Number of liver metastases,serum CEA concentration,complication are important prognostic factors for liver metastases from colorectal cancer.Appropriate expansion of surgical indication,early diagnosis with intensive follow-up is crucial to increase the survival rate after hepatectomy for liver metastasis of coloractal carcinoma.