Clinicopathological features and prognosis in resectable synchronous and metachronous colorectal liver metastasis
Clinicopathological features and prognosis in resectable synchronous and metachronous colorectal liver metastasis
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DOI：
10.1245/s10434-006-9215-5
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发表时间：
2007-02-01
影响因子：
3.7
通讯作者：
Lee, Po-Huang
中科院分区：
文献类型：
--
作者：
Tsai, Ming-Shian;Su, Yen-Hao;Lee, Po-Huang
前言：肝切除可为结直肠转移瘤患者提供长期生存。然而，关于预后因素仍存在争议。本研究旨在探讨肝转移的同步性对结肠癌患者临床病理特征及预后的影响。方法：选择1995年至2004年因结肠癌肝转移而行肝切除术的患者155例。将患者分为两组：同时性和异时性结直肠癌肝转移。分析患者的人口学特征、原发肿瘤和转移性肿瘤的性质、手术相关并发症和远期预后。结果：同步组的患者比异时性组的患者更年轻。与异时性组相比，同步组转移更多(P=0.008)，双侧分布转移更多(P=0.016)。胆漏是最常见的手术并发症。5年无瘤生存率和总生存率分别为16.8%和41.1%。单因素分析显示，同步转移、原发灶分期、转移灶的双叶分布、3个以上的转移灶、原发灶位于结肠与直肠的位置是影响无瘤生存期较短的预后因素，但不是影响总生存期的因素。多因素分析显示，同步转移和晚期原发肿瘤患者的无病生存期较差。结论：原发结肠癌和肝转移的同步存在可能预示着疾病更易扩散，并且与异时转移相比，无瘤生存期更短。这些患者在根治性切除后可能需要更仔细的监测和积极的化疗。
Introduction: Hepatic resection may offer long-term survival for patients with colorectal metastases. However, controversies exist regarding the prognostic factors. Herein, the impact of synchronicity of liver metastasis on patient clinicopathological features and prognosis was evaluated.Methods: One hundred and fifty-five patients who underwent hepatectomy for colon cancer metastasis, from 1995 to 2004, were enrolled in this study. Patients were divided into two groups: synchronous and metachronous colorectal liver metastasis. Patient demographics, the nature of the primary and metastatic tumors, surgery-related complications, and long-term outcome were analyzed.Results: Patients included in the synchronous group tended to be younger than those in the metachronous group. Compared to the metachronous group, patients in the synchronous group showed more metastases (P = 0.008) and bilobarly distributed metastases (P = 0.016). Bile leakage was the most common surgical complication. The estimated 5-year disease-free and overall survival rates were 16.8 and 41.1%, respectively. Univariate analysis indicated that synchronous metastases, advanced stage of the primary tumor, bilobar distribution of the metastases, more than three metastases, and colonic versus rectal location of the primary tumor were prognostic factors of shorter disease-free survival, but not overall survival. Multivariate analysis revealed that synchronous metastases and the advanced stage of the primary tumor were indicators for a worse disease-free survival.Conclusion: The synchronous presence of primary colon cancer and liver metastasis may indicate a more disseminated disease status and is associated with a shorter disease-free survival than metachronous metastasis. These patients may need more careful monitoring and aggressive chemotherapy following curative resection.