同时性结直肠癌肝转移患者的生存分析

目的分析结直肠癌合并同时性肝转移患者的生存状况和相关影响因素。 方法回顾性分析2000年至2010年复旦大学附属中山医院收治的1061例结直肠癌合并同时性肝转移患者的病例。收集所有患者的临床资料、病理特征、治疗策略、住院费用、随访状况等，进行生存状况分析，并采用单因素和Cox比例风险回归模型等分析影响结直肠癌肝转移生存的相关因素。 结果肝转移灶可切除患者中，同期切除肠道原发灶和肝转移灶与分期切除患者的住院费用分别为25693元、34129元(P<0.05)，手术并发症(分别为24.5%、20.5%)和总生存期方面(分别为48.5月、47.0月)无显著差异。肝转移灶不可切除且原发灶无症状的患者中，原发灶切除的患者总体中位生存时间明显好于原发灶未切除的患者(分别为19.0月、9.3月，P<0.001)。肠道原发灶分化Ⅲ～Ⅳ级、肝转移灶≥4个、最大肝转移灶直径≥5 cm、肝外转移、肠道原发灶未手术切除和肝转移灶非手术治疗是影响肠癌同时性肝转移患者预后的独立危险因素。将上述6个危险因素各设定为1分，所有患者分为低风险组(0～1分)、中风险组(2～3分)和高风险组(4～6分)，5年存活率分别为51%、16%和0%(P<0.001)。 结论结直肠癌合并同时性肝转移患者中，原发灶和转移灶均可切除的可予以同期切除，原发灶可切除且无出血梗阻症状的不可切除的肝转移仍建议在合适时机切除肠道原发灶。根据上述6个独立预后因素所建立的预测模型可以指导临床采取合适的治疗方案。

Surviv alanalysis of synchronous colorectal liver metastases

ObjectiveTo conducte survival analysis of synchronous colorectal liver metastases(SCRLM). MethodsRetrospectively collected clinicopathologic data of 1061 SCRLM patients, and then conducted univariate and Cox regression analyses. ResultsFor patients with resectable SCRLM, synchronous resection could reduce the expense compared with asynchronous resection, while there were no significant differences in short-term complications or long-term survival.For asymptomatic unresectable SCRLM patients, resection of primary tumor could improve long-term survival.Poor differentiation of primary tumor, number of liver metastases≥4, maximum liver metastasis≥5 cm, extra-liver metastases, no resection of primary tumor and no surgical treatment of liver metastases were independent prognosis factors.Giving one point to each above factor, all SCRLM patients were divided into low-risk(0~1), medium-risk(2~3)and high-risk(4~6)groups which 5-year-survival rates are 51%, 16% and 0% respectively. ConclusionsIn patients with resectable SCRLM, synchronous resection of primary tumor and liver metastases was the optimal choice.In asymptomatic patients with unresectable SCRLM, resection of primary tumor was recommended at the right time.The prediction model should be used to guide clinical management of SCRLM patients.