Hepatic resection for metastatic colorectal adenocarcinoma: A proposal of a prognostic scoring system
Hepatic resection for metastatic colorectal adenocarcinoma: A proposal of a prognostic scoring system
复制标题
DOI：
10.1016/s1072-7515(99)00089-7
复制
发表时间：
1999-09-01
影响因子：
5.2
通讯作者：
Starzl, TE
中科院分区：
文献类型：
--
作者：
Iwatsuki, S;Dvorchik, I;Starzl, TE
背景：肝切除术治疗转移性结直肠癌为相当大比例的患者提供了良好的长期结果。尽管已经确定了各种预后危险因素，但对于转移性肝肿瘤还没有可靠的分期或预后评分系统。 研究设计：对 305 名未接受原发性肝切除术的转移性结直肠癌连续患者进行了各种临床和病理危险因素检查。通过 Cox 比例风险模型使用以下方程估计生存率：S(t) = [S-o(t)](exp(R-Ro))，其中 S-o(t) 是没有任何已确定危险因素且 R-o = 0 的患者的生存率。结果：初步多变量分析显示，独立显着的阴性预后因素为：(1) 手术切缘阳性，(2) 肝外肿瘤累及，包括淋巴结，(3) 肿瘤三个或以上的数量，(4) 双叶肿瘤，以及 (5) 从原发肿瘤治疗到肝复发的时间为 30 个月或更短。由于 62 名切缘阳性或肝外肿瘤患者的生存率均非常差，因此对其余 243 名不具有这些致死危险因素的患者重复进行了多变量分析。再分析显示，独立显着的不良预后因素为：(1) 肿瘤数量为 3 个或更多，(2) 肿瘤大小大于 8 厘米，(3) 肝复发时间为 30 个月或更短，以及 (4) 双叶肿瘤。通过多变量分析的系数求和计算被剔除队列（n = 243）肿瘤复发的风险评分（R），并将其分为五组：1级，无风险因素（R = 0）； 2级，一个危险因素（R = 0.3至0.7）； 3级，两个危险因素（R = 0.7至1.1）； 4级，三个危险因素（R = 1.2至1.6）； 5 级，四个危险因素（R > 1.6）。 6级由62例被剔除的切缘阳性或肝外肿瘤的患者组成。 Kaplan-Meier 和 Cox 比例风险估计 1 至 6 级患者的 5 年生存率分别为 48.3% 和 48.3%、36.6% 和 33.7%、19.9% 和 17.9%、11.9% 和 6.4%、0% 和 1.1%、0% 和 0%（p < 0.0001).结论：所提出的风险评分分级非常好地预测了生存差异。 Cox 比例风险模型确定的估计生存率与 Kapian-Meier 方法确定的估计生存率相似。拟议系统的验证和进一步改进正在等待其他中心或国际合作研究。 （J Am Cell Surg 1999；189：291-299。(C) 1999 年，美国外科医生学会）。
Background: Hepatic resection for metastatic colorectal cancer provides excellent longterm results in a substantial proportion of patients. Although various prognostic risk factors have been identified, there has been no dependable staging or prognostic scoring system for metastatic hepatic tumors.Study Design: Various clinical and pathologic risk factors were examined in 305 consecutive patients who undenwent primary hepatic resections for metastatic colorectal cancer. Survival rates were estimated by the Cox proportional hazards model using the equation: S(t) = [S-o(t)](exp(R-Ro)), where S-o(t) is the survival rate of patients with none of the identified risk factors and R-o = 0.Results: preliminary multivariate analysis revealed that independently significant negative prognosticators were: (1) positive surgical margins, (2) extrahepatic tumor involvement including the lymph node(s), (3) tumor number of three or more, (4) bilobar tumors, and (5) time from treatment of the primary tumor to hepatic recurrence of 30 months or less. Because the survival rates of the 62 patients with positive margins or extrahepatic tumor were uniformly very poor, multivariate analysis was repeated in the remaining 243 patients who did not have these lethal risk factors. The reanalysis revealed that independently significant poor prognosticators were: (1) tumor number of three or more, (2) tumor size greater than 8 cm, (3) time to hepatic recurrence of 30 months or less, and (4) bilobar tumors. Risk scores (R) for tumor recurrence of the culled cohort (n = 243) were calculated by summation of coefficients from the multivariate analysis and were divided into five groups: grade 1, no risk factors (R = 0); grade 2, one risk factor (R = 0.3 to 0.7); grade 3, two risk factors (R = 0.7 to 1.1); grade 4, three risk factors (R = 1.2 to 1.6); and grade 5, four risk factors (R > 1.6). Grade 6 consisted of the 62 culled patients with positive margins or extrahepatic tumor. Kaplan-Meier and Cox proportional hazards estimated 5-year survival rates of grade 1 to 6 patients were 48.3% and 48.3%, 36.6% and 33.7%, 19.9% and 17.9%, 11.9% and 6.4%, 0% and 1.1%, and 0% and 0%, respectively (p < 0.0001).Conclusions: The proposed risk-score grading predicted the survival differences extremely well. Estimated survival as determined by the Cox proportional hazards model was similar to that determined by the Kapian-Meier method. Verification and further improvements of the proposed system are awaited by other centers or international collaborative studies. (J Am Cell Surg 1999;189:291-299. (C) 1999 by the American College of Surgeons).