Multivariate Analysis of a Personal Series of 247 Consecutive Patients with Liver Metastases from Colorectal Cancer: I. Treatment by Hepatic Resection
Multivariate Analysis of a Personal Series of 247 Consecutive Patients with Liver Metastases from Colorectal Cancer: I. Treatment by Hepatic Resection
复制标题
对 247 名连续结直肠癌肝转移患者的个人系列进行多变量分析：I. 肝切除治疗
作者：
J. Fortner;J. S. Silva;R. Golbey;E. B. Cox;B. Maclean
在美国，估计每年有5000到6000名新患者可能会接受大范围肝切除术来治疗复发的结肠癌。自1971年以来，这里报道的计划评估了可能影响这种方法的治疗潜力的各种因素。1971年3月至1982年5月，65例患者接受了大范围肝切除。使用逐步比例风险分析，所有存储在CLINFO(由Bolt，Beranek和Newman；波士顿，MA)存储的数据被评估多变量对切除的肝转移患者生存的影响。27例行右肝叶切除，14例行扩大右肝切除，1例行尾状叶切除，10例行左叶切除，9例行左外叶切除，5例行肝大部切除，对侧肝叶转移灶进行三维楔形切除。接受标准肝大部切除术的患者30天手术死亡率为7%(4/58)。在早期使用隔离-低温灌流技术的7名患者中，这一比例为14%。在10名患者中，仅需要楔形切除来切除肿瘤。I期疾病被定义为仅局限于肝脏切除部分而不侵犯肝内主要血管或胆管的肿瘤。II期为区域性扩散，III期为转移至淋巴结或区域外部位。37例I期患者的3年生存率估计为66%。13例II期患者的3年生存率估计为58%。9名III期患者中有5名目前存活3至23个月；另外4名患者在发病35个月时死亡。肝病分期是生存分析中最显著的变量(p=0.02)；Dukes‘s对结直肠癌的分类在p<；0.05有显著意义。那些被发现不是生存显著决定因素的因素是：转移性肝沉积的数量、原发结肠癌的位置、年龄、性别、术前肝功能测试和CEA。
In the United States, there are an estimated 5000 to 6000 new patients annually who might be candidates for major hepatic resection to treat their recurrent colon cancer. Since 1971, the program reported here has evaluated various factors that might influence the curative potential of such an approach. Sixty-five patients had a major hepatic resection from March 1971 through May 1982. Using a stepwise proportional hazard analysis, all data that had been stored in CLINFO (a data analysis system by Bolt, Beranek and Newman; Boston, MA) were evaluated for the effect of multiple variables on the survival of patients with resected hepatic metastases. Twenty-seven had a right hepatic lobectomy; 14 had extended right hepatectomy with one having the caudate lobe also removed; ten had left lobectomy, nine had left lateral segmentectomy; and five had a major hepatic resection with three-dimensional wedge excision of a metastatic deposit in the contralateral lobe. The 30-day operative mortality rate was 7% (4/58) for patients undergoing the standard major hepatic resection. It was 14% for seven patients in whom the isolation-hypothermic perfusion technique was used early in the series. In ten patients, wedge excision only was required to remove the tumor. Stage I disease is defined as tumor confined to the resected portion of the liver without invasion of major intrahepatic vessels or bile ducts. Stage II disease is regional spread and Stage III disease is metastasis to lymph nodes or extraregional sites. The 3-year survival estimate was 66% for the 37 patients with Stage I disease. The 3-year survival estimate for 13 patients with Stage II disease was 58%. Five of the nine patients with Stage III disease are presently alive from 3 to 23 months; one of the other four died at 35 months of disease. The stage of liver disease was the most significant variable in this survival analysis (p = 0.02); Dukes' classification of colorectal primary was significant at p < 0.05. Those factors found not to be significant determinants of survival were: number of metastatic hepatic deposits, site of colon primary, age, sex, preoperative liver function tests, and CEA.