Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer - Analysis of 1001 consecutive cases
Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer - Analysis of 1001 consecutive cases
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DOI：
10.1097/00000658-199909000-00004
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发表时间：
1999-09-01
影响因子：
9
通讯作者：
Blumgart, LH
中科院分区：
文献类型：
--
作者：
Fong, Y;Fortner, J;Blumgart, LH
目的有必要制定明确且广泛适用的临床标准来选择转移性结直肠癌肝切除患者。方法对1985年7月至1998年10月连续1001例因转移性结直肠癌行肝切除术的患者的临床、病理和预后资料进行分析。这些切除包括237例三叶切除，394例肺叶切除，370例叶以下切除。结果5年生存率为37%，10年生存率为22%。多因素分析发现，切缘阳性(p=0.004)、肝外疾病(p=0.003)、原发灶阳性(p=0.02)、无瘤1例(p=0.0004)、最大肝肿瘤5 cm(p=0.0004)、癌胚抗原水平(p=0.01)、癌胚抗原水平(p=0.01)等7个因素对远期预后有显著影响。200 ng/ml(p=0.01)。当这些标准中的最后五个标准用于术前评分系统时，为每个标准分配一分，总分对结果具有很高的预测性(p<；0.0001)。5分以上患者无一例长期存活。结论切除肝转移瘤可获得长期生存和治愈。根据五个标准可以预测长期结果，这五个标准对所有考虑切除的患者都是现成的。符合两个标准的患者可以有良好的结果。符合3、4或5个标准的患者应考虑进行实验性辅助试验。术前分期技术或辅助治疗的研究应该考虑使用这样的评分来对患者进行分层。
ObjectiveThere is a need for dearly defined and widely applicable clinical criteria for the selection of patients who may benefit from hepatic resection for metastatic colorectal cancer. Such criteria would also be useful for stratification of patients in clinical trials for this disease.MethodsClinical, pathologic, and outcome data for 1001 consecutive patients undergoing liver resection for metastatic colorectal cancer between July 1985 and October 1998 were examined. These resections included 237 trisegmentectomies, 394 lobectomies, and 370 resections encompassing less than a lobe. The surgical mortality rate was 2.8%.ResultsThe 5-year survival rate was 37%, and the 10-year survival rate was 22%, Seven factors were found to be significant and independent predictors of poor long-term outcome by multivariate analysis: positive margin (p = 0.004), extrahepatic disease (p = 0.003), node-positive primary (p = 0.02), disease-free interval from primary to metastases 1 (p = 0.0004), largest hepatic tumor >5 cm (p = 0.01), and carcinoembryonic antigen level >200 ng/ml (p = 0.01). When the last five of these criteria were used in a preoperative scoring system, assigning one point for each criterion, the total score was highly predictive of outcome (p < 0.0001). No patient with a score of 5 was a long-term survivor.ConclusionResection of hepatic colorectal metastases may produce long-term survival and cure. Long-term outcome can be predicted from five criteria that are readily available for all patients considered for resection. Patients with up to two criteria can have a favorable outcome. Patients With three, four, or five criteria should be considered for experimental adjuvant trials. Studies of preoperative staging techniques or of adjuvant therapies should consider using such a score for stratification of patients.