Colorectal cancer liver metastases - a population-based study on incidence, management and survival.
Colorectal cancer liver metastases - a population-based study on incidence, management and survival.
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DOI：
10.1186/s12885-017-3925-x
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发表时间：
2018-01-15
期刊：
影响因子：
3.8
通讯作者：
Freedman J
中科院分区：
文献类型：
--
作者：
Engstrand J;Nilsson H;Strömberg C;Jonas E;Freedman J
结直肠癌 (CRC) 是癌症相关死亡的主要原因，其中 25-30% 的患者发生肝转移。先前的数据表明，尽管左侧癌症的肝转移发生率较高，但右侧和左侧肝转移性结直肠癌之间的生存率存在差异。该研究的目的是描述肝转移模式和生存率与原发肿瘤特征和转移性疾病不同组合的关系。对 2008 年瑞典斯德哥尔摩地区诊断为 CRC 的一组患者进行了一项基于人群的回顾性研究。通过瑞典国家结直肠癌治疗质量登记处 (SCRCR) 确定患者，并从电子患者记录中检索有关肝内和肝外转移模式和治疗的其他信息。患者被随访 5 年或直至死亡。通过 Cox 回归研究影响总生存期 (OS) 的因素。使用 Kaplan-Meier 估计和对数秩检验比较 OS。 272/1026 (26.5%) 患者在原发灶诊断后五年内诊断出肝转移。与右侧结肠癌相比，左侧结肠癌更常诊断出肝脏和肺转移（分别为 28.4% vs 22.1%，p = 0.029 和 19.7% vs 13.2%，p = 0.010），但与左侧相比，右侧结肠癌的肝转移范围更广泛(p = 0.001)。与右侧癌症相比，包括直肠癌在内的肝转移性左侧癌症的死亡风险降低了 44%（HR = 0.56，95% CI：0.39–0.79），5 年 OS 分别为 16.6% 和 4.3%（p < 0.001）。在肝转移性 CRC 中，根据多变量分析评估，肺转移的存在并未显着影响 OS（HR = 1.11，95% CI：0.80–1.53）。肝转移性右侧结肠癌的生存率较差，可能是因为与左侧结肠癌和直肠癌相比，转移灶数量较多，且节段受累更广泛，尽管后者的肝转移发生率较高。关于 CRC 转移模式和生存的详细的基于人群的数据有助于为 CRC 患者的随访制定更加结构化和个性化的指南。本文的在线版本 (10.1186/s12885-017-3925-x) 包含补充材料，可供授权用户使用。
Colorectal cancer (CRC) is a leading cause of cancer-associated deaths with liver metastases developing in 25–30% of those affected. Previous data suggest a survival difference between right- and left-sided liver metastatic CRC, even though left-sided cancer has a higher incidence of liver metastases. The aim of the study was to describe the liver metastatic patterns and survival as a function of the characteristics of the primary tumour and different combinations of metastatic disease. A retrospective population-based study was performed on a cohort of patients diagnosed with CRC in the region of Stockholm, Sweden during 2008. Patients were identified through the Swedish National Quality Registry for Colorectal Cancer Treatment (SCRCR) and additional information on intra- and extra-hepatic metastatic pattern and treatment were retrieved from electronic patient records. Patients were followed for 5 years or until death. Factors influencing overall survival (OS) were investigated by means of Cox regression. OS was compared using Kaplan-Meier estimations and the log-rank test. Liver metastases were diagnosed in 272/1026 (26.5%) patients within five years of diagnosis of the primary. Liver and lung metastases were more often diagnosed in left-sided colon cancer compared to right-sided cancer (28.4% versus 22.1%, p = 0.029 and 19.7% versus 13.2%, p = 0.010, respectively) but the extent of liver metastases were more extensive for right-sided cancer as compared to left-sided (p = 0.001). Liver metastatic left-sided cancer, including rectal cancer, was associated with a 44% decreased mortality risk compared to right-sided cancer (HR = 0.56, 95% CI: 0.39–0.79) with a 5-year OS of 16.6% versus 4.3% (p < 0.001). In liver metastatic CRC, the presence of lung metastases did not significantly influence OS as assessed by multivariate analysis (HR = 1.11, 95% CI: 0.80–1.53). The worse survival in liver metastatic right-sided colon cancer could possibly be explained by the higher number of metastases, as well as more extensive segmental involvement compared with left-sided colon and rectal cancer, even though the latter had a higher incidence of liver metastases. Detailed population-based data on the metastatic pattern of CRC and survival could assist in more structured and individualized guidelines for follow-up of patients with CRC. The online version of this article (10.1186/s12885-017-3925-x) contains supplementary material, which is available to authorized users.
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