CAJ | 학술논문

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)和菲早期复发患者的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5 cm)是CRLM早期复发的独立危险因素;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.
목적 탐토이차간절제대결직장암간전이(CRLM)술후조기복발환자예후적영향,병분석CRLM술후조기복발적위험인소.방법 회고성분석2000년1월지2014년8월간우북경종류의원간담이외일과행수술절제적303례CRLM환자적림상병리급수방자료.관찰전조적생존정황,비교조기복발(1년내복발)화비조기복발환자적5년생존솔,분석이차간절제술대조기복발환자5년생존솔적영향,병대가능영향환자조기복발적림상병리특정진행단인소화다인소분석.결과 전조303례환자중,192례(63.4％)출현술후복발,기중조기복발145례、비조기복발47례,조기복발환자적5년생존솔명현저우비조기복발자[16.0％비63.9％,P=0.000].145례조기복발환자중,80례(55.2％)피재차평고위가절제,기중22례접수이차간절제술환자적5년생존솔명현고우비수술치료적58례환자[27.1％비0,P=0.033].다인소분석현시,원발조침윤정도심(T3～T4)화림파결전이급간전이조대(대우5 cm)시CRLM조기복발적독립위험인소;이술전신보조치료유효(종류완전완해혹부분완해)시CRLM조기복발적독립보호성인소(균P＜0.05).결론 CRLM경수술절제후조기복발환자적예후교차,단복발후평고위가절제적환자접수이차간절제술,능구현저연장생존시간.대우원발조침윤정도심、림파결전이화간전이조대적환자,가고필행적겁적술전신보조치료.
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 survivals 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 be associated with early recurrence were investigated using univariate and multivariate analyses.Results Among 303 patients, 192 (63.4％) patients had recurrence,including 145 patients of early recurrence and 47 of non-early recurrence.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 resectable, of whom 22received 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 nodc 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.