Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer - A multifactorial model of 929 patients
Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer - A multifactorial model of 929 patients
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DOI：
10.1097/sla.0b013e31815aa2c2
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发表时间：
2008-01-01
影响因子：
9
通讯作者：
John, Timothy G.
中科院分区：
文献类型：
--
作者：
Rees, Myrddin;Tekkis, Paris P.;John, Timothy G.
目的：研究转移性结直肠癌一期肝切除术后肿瘤特异性生存的危险因素，并建立一种预测模型。背景：尚未有文献集体研究转移性结直肠癌肝切除术后患者肿瘤特异性生存相关因素的相互关系。方法：前瞻性收集1987年至2005年在三级转诊中心接受初次肝切除(n=925)或再次肝切除(n=80)的929例转移性结直肠癌肝转移患者的临床、病理和完整的随访数据。参数生存分析被用来识别癌症特异性生存的预测因素，并开发预测模型。结果：术后死亡率为1.5%，发病率为25.9%。5年和10年癌症相关生存率分别为36%和23%。经多因素分析，有7个危险因素为预后不良的独立危险因素：肝转移数>3、原发灶阳性、原发低分化、肝外病变、肿瘤直径>5 cm、癌胚抗原水平>60 ng/mL、切缘阳性。其中前6项标准用于术前评分系统，后6项标准用于术后评估。术后预后标准最差的患者预期癌症特异性中位生存期为0.7年，5年癌症特异性生存率为2%。相反，具有最佳预后标准的患者预期癌症特异性中位生存期为7.4年，5年癌症特异性生存率为%。当检验时，两个预测模型都很好地符合数据，在观察和预测结果之间没有显著差异(P>；0.05)。结论：肝转移瘤切除提供了良好的长期癌症特有的生存益处，可以在手术前或手术后使用所描述的标准来量化。“贝辛斯托克预测指数”可用于危险分层患者，这些患者可能受益于对辅助治疗和试验的密切监测和选择。
Objective: To identify risk factors associated with cancer-specific survival and develop a predictive model for patients undergoing primary hepatic resection for metastatic colorectal cancer.Background: No published studies investigated collectively the inter-relation of factors related to patient cancer-specific survival after hepatectomy for metastatic colorectal cancer.Methods: Clinical, pathologic, and complete follow-up data were prospectively collected from 929 consecutive patients undergoing primary (n = 925) or repeat hepatic resection (n = 80) for colorectal liver metastases at a tertiary referral center from 1987 to 2005. Parametric survival analysis was used to identify predictors of cancer-specific survival and develop a predictive model. The model was validated using measures of discrimination and calibration.Results: Postoperative mortality and morbidity were 1.5% and 25.9%, respectively. 5-year and 10-year cancer-specific survival were 36% and 23%. On multivariate analysis, 7 risk factors were found to be independent predictors of poor survival: number of hepatic metastases >3, node positive primary, poorly differentiated primary, extrahepatic disease, tumor diameter >= 5 cm, carcinoembyonic antigen level >60 ng/mL, and positive resection margin. The first 6 of these criteria were used in a preoperative scoring system and the last 6 in the postoperative setting. Patients with the worst postoperative prognostic criteria had an expected median cancer-specific survival of 0.7 years and a 5-year cancer-specific survival of 2%. Conversely, patients with the best prognostic postoperative criteria had an expected median cancer-specific survival of 7.4 years and a 5-year cancer-specific survival of 64%. When tested both predictive models fitted the data well with no significant differences between observed and predicted outcomes (P > 0.05).Conclusion: Resection of liver metastases provides good long-term cancer-specific survival benefit, which can be quantified pre- or postoperatively using the criteria described. The "Basingstoke Predictive Index" may be used for risk-stratifying patients who may benefit from intensive surveillance and selection for adjuvant therapy and trials.