Outcome of Patients with Colorectal Liver Metastasis: Analysis of 1,613 Consecutive Cases
Outcome of Patients with Colorectal Liver Metastasis: Analysis of 1,613 Consecutive Cases
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结直肠肝转移患者的转归：1,613例连续病例分析
DOI：
10.1245/s10434-012-2356-9
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发表时间：
2012-09-01
影响因子：
3.7
通讯作者：
Xu Jianmin
中科院分区：
文献类型：
--
作者：
Zhu Dexiang;Ren Li;Xu Jianmin
本研究旨在评估接受不同类型治疗的结直肠肝转移（CRLM）患者的长期结局并确定预后因素。结果同步性肝转移（SLM）、女性、Ⅲ ~ Ⅳ级、原发灶T4和N阳性、双叶病变、肝转移灶数目≥4个、最大肝转移灶直径≥5 cm、血清CEA水平≥5 ng/ml、CA 19 -9水平≥37 u/ml是预后不良的预测因素。肝转移瘤切除后患者的中位生存期和5年生存率分别为49.8个月和47%，优于其他治疗后的患者。此外，未接受治疗的患者生存率最低。64例最初不可切除的患者在转换治疗后接受了手术，中位生存期为36.9个月，5年生存率为30%。多因素分析显示，SLM、原发灶低分化、肝转移灶≥4个、最大肝转移灶≥5 cm、未行手术治疗是CRLM患者生存不良的独立预测因素。使用上述五个因素的预测模型可能用于对可能受益于强化监测和辅助治疗的患者进行分层。
ObjectiveThis study was designed to evaluate the long-time outcome of patients with colorectal liver metastasis (CRLM) undergoing different types of therapy and identify prognosis factors.MethodsFrom 2000 to 2010, 1,613 consecutive patients with CRLM were identified. Clinicopathological and outcome data were collected and analyzed by univariate and multivariate analyses.ResultsSynchronous liver metastasis (SLM), female, grade III-IV, T4 and N positive of primary tumor, bilobar disease, number of liver metastases ≥4, size of largest liver metastases ≥5 cm, serum CEA level ≥5 ng/ml, and CA19-9 level ≥37 u/ml were the predictors of adverse outcome using univariate analysis. The median survival and 5-year survival rate for patients after resection of liver metastases was 49.8 months and 47%, better than that for those after other therapy. In addition, patients without treatment had the poorest survival. Sixty-four initially unresectable patients underwent surgery after conversion therapy with a median survival of 36.9 months and a 5-year survival of 30%. By multivariate analysis, SLM, poorly differentiated primary tumor, number of liver metastases ≥4, size of largest liver metastases ≥5 cm, and no surgical treatment of liver metastases were found to be independent predictors of poor survival.ConclusionsPatients with CRLM could get long-term survival benefit from different types of therapy, and resection of liver metastases was the optimal strategy. A predictive model using these above five factors may be of use in stratifying patients who may benefit from intensive surveillance and adjuvant therapy.