Clinicopathological analysis of recurrence patterns and prognostic factors for survival after hepatectomy for colorectal liver metastasis.
Clinicopathological analysis of recurrence patterns and prognostic factors for survival after hepatectomy for colorectal liver metastasis.
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DOI：
10.1186/1471-2482-10-27
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发表时间：
2010-09-27
期刊：
影响因子：
1.9
通讯作者：
Tanigawa N
中科院分区：
文献类型：
--
作者：
Hayashi M;Inoue Y;Komeda K;Shimizu T;Asakuma M;Hirokawa F;Miyamoto Y;Okuda J;Takeshita A;Shibayama Y;Tanigawa N
肝切除术被推荐为结直肠癌肝转移最有效的治疗方法。阐明影响预后的临床病理因素至关重要。对83例CRCLM行初次肝切除的患者的临床资料进行了回顾性分析，分析了原发结直肠肿瘤和肝转移瘤的特点、手术细节和预后。CRCLM初次肝切除后总的5年生存率为57.5%，中位生存期为25个月。单因素分析显示，预后不良的显著因素为：原发结直肠癌深度(≥浆膜侵犯)、肝切除切缘(<lt；5 mm)、门静脉侵犯、肝内外复发。多变量分析表明，肝内外复发是预后不良的独立预测因素。肝内复发的危险因素是CRCLM的切除切缘(<；5 mm)，而肝外复发的危险因素未见报道。在同期CRCLM亚组中，手术结合辅助化疗控制了肝内复发，明显改善了预后。对于有复发和预后不良危险因素的患者，需要制定最佳的手术策略和有效的化疗方案，如上所述。
Hepatectomy is recommended as the most effective therapy for liver metastasis from colorectal cancer (CRCLM). It is crucial to elucidate the prognostic clinicopathological factors. Eighty-three patients undergoing initial hepatectomy for CRCLM were retrospectively analyzed with respect to characteristics of primary colorectal and metastatic hepatic tumors, operation details and prognosis. The overall 5-year survival rate after initial hepatectomy for CRCLM was 57.5%, and the median survival time was 25 months. Univariate analysis clarified that the significant prognostic factors for poor survival were depth of primary colorectal cancer (≥ serosal invasion), hepatic resection margin (< 5 mm), presence of portal vein invasion of CRCLM, and the presence of intra- and extrahepatic recurrence. Multivariate analysis indicated the presence of intra- and extrahepatic recurrence as independent predictive factors for poor prognosis. Risk factors for intrahepatic recurrence were resection margin (< 5 mm) of CRCLM, while no risk factors for extrahepatic recurrence were noted. In the subgroup with synchronous CRCLM, the combination of surgery and adjuvant chemotherapy controlled intrahepatic recurrence and improved the prognosis significantly. Optimal surgical strategies in conjunction with effective chemotherapeutic regimens need to be established in patients with risk factors for recurrence and poor outcomes as listed above.
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