目的 探讨同时性结直肠癌肝转移患者的外科手术疗效并分析影响其预后的因素.方法 回顾性分析2013年6月至2018年1月上海交通大学附属第六人民医院和同济大学附属杨浦医院收治的47例同时性结直肠癌肝转移患者临床资料,观察手术治疗的短期和长期疗效,并采用COX方法进行多因素分析影响预后的独立因素.结果 所有患者均获得随访,中位随访时间38个月(2~65个月).47例患者均行同时性结直肠与肝肿瘤根治术.41例患者行术后化疗,6例未行化疗.全组患者无围手术期死亡,术后并发症发生率为34%,均经非手术治疗措施获得治愈或明显缓解.全组患者的1、3和5年生存率分别为87%、53%和15%,其中无瘤生存率分别为81%、43%和9%.多因素分析结果显示:原发肿瘤分化程度、确诊时血清CEA水平及是否行辅助化疗为影响同时性结直肠癌肝转移患者的独立预后因素(P<0.05).结论 对同时性结直肠癌肝转移患者,同期行结直肠病灶和肝转移灶切除是目前最主要的治疗方式,患者的长期生存与原发肿瘤分化程度、确诊时血清CEA水平及术后辅助化疗密切相关.
Objective To evaluate curative effect and related prognosis factors of synchronous colorectal cancer with liver metastasis.Methods The clinicopathological and follow-up data of 47 patients undergoing surgical treatment with synchronous colorectal cancer with liver metastasis at Shanghai Jiaotong University Affiliated Sixth People's Hospital and Tongji University Affiliated Yangpu Hospital from Jun 2013 to Jan 2018 were retrospectively analyzed.Results All 47 patients were followed up and themedian followup time was 38 months (2-65 months),after simultaneous colorectal and hepatic neoplasm radical surgery,added in 41 patients by postoperative chemotherapy.There was no perioperative mortality and the postoperative complication rate was 34%.The 1-,3-,and 5-year overall-survival rates were 87%,53%,and 15%,respectively.The disease-free survival rates were 81%,43%,and 9%,respectively.Multivariate results showed tumor differentiation,serum CEA level and adjuvant chemotherapy are independent prognostic factors for patients with synchronous colorectal cancer liver metastasis (P < 0.05).Conclusions Colorectal cancer with synchronous liver metastasis treated by simultaneous resection of colorectal cancer and liver metastases are the widerly adopted treatments.Long-term survival is closely related to the degree of primary neoplasm differentiation,serum CEA level at diagnosis,and postoperative adjuvant chemotherapy.