结直肠癌术前经肝动脉联合区域动脉灌注化疗的安全性评价

目的 评价术前肝动脉联合区域动脉灌注化疗预防结直肠癌根治术后肝转移的安全性.方法 2001-2007年收治的Ⅱ期和Ⅲ期结直肠癌患者随机分成术前肝动脉联合区域动脉灌注化疗组(介入组,n=256)和对照组(n=253).对两组围手术期的血常规、肝功能、免疫指标、并发症情况等进行评价.结果 介入组介入术后7天(手术前)Ⅲ级肝功能异常、白细胞减少、贫血和血小板减少发生率分别为3.1%(8/256)、5.5%(14/256)、7.4%(19/256)、6.6%(17/256),无Ⅳ级毒副反应,全组均顺利接受手术.介入组和对照组手术后并发症发生率分别为9.8%(25/256)及8.3%(21/253)(X2=1.86,P＞0.05).截至2007年10月,所有患者均接受了随访,平均随访时间42±14个月.介入组和对照组Ⅲ期患者5年总生存率分别为81.0%:60.4%(X2=5.15,P＜0.05)、5年肝转移率分别为18.9%(28/148):27.3%(41/150)(X2=5.41,P＜0.05),Ⅱ期患者肝功能异常、白细胞减少、贫血和血小板减少和免疫指标、并发症情况等两组无差异.结论 术前肝动脉联合区域动脉灌注化疗对结直肠癌手术影响较小,不增加术后并发症的发生,而且可显著降低Ⅲ期结直肠癌术后肝转移发生率,延长患者生存期.

Preoperative hepatic and regional arterial infusion chemotherapy in the prevention of liver metastasis after colorectai cancer surgery

Objective To investigate the safety of preoperative hepatic and regional arterial infusion chemotherapy in the prevention of liver metastasis and improving survival after curative colorectal cancer resection.Methods Patients admitted from 2001 to 2007 with Stage Ⅱ or Stage Ⅲ colorectal cancer were randomly assigned to receive preoperative hepatic and regional arterial infusion chemotherapy (PHRAIC group,n=256)or surgery alone(control group,n=253).Toxity of liver,hematology,immunology and post-operative complication of PHRAIC and the control were evaluated.Results Grade Ⅲ hepatic toxity,leukemia,anemia and platelet decrease in PHRAIC group was 3.1%(8/256),5.5% (14/256),7.4%(19/256)and 6.6%(17/256).There were no grade Ⅳ toxities,and all the patients in PHRAIC group received surgery.Morbidity rate in PHRAIC and the control group was 9.8%(25/256)vs 8.3%(21/253)(X2=1.86,P＞0.05).All patients were followed up,with mean follow up of 42±14 months until Oct 30.2007.For stage Ⅲ patients,5-year overall survival and liver metastasis rate were 81.0% in PHRAIc group vs.60.4% in control group(X2=5.15,P＜0.05)and 18.9%(28/148)vs 27.3%(41/150)(X2=5.41,P＜0.05),respectively.Conclusion Preoperative hepatic and regional arterial infusion chemotherapy 7 days before surgery was safe and could reduce liver metastasis and improve survival rate in patients with Stage Ⅲ colorectal cancer.