Imamura H, Matsuyama Y, Shimada R, Kubota M, Nakayama A, Kobayashi A, Kitamura H, Ikegami T, Miyagawa S I, Kawasaki S
First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Am J Gastroenterol. 2001 Nov;96(11):3178-84. doi: 10.1111/j.1572-0241.2001.05278.x.
The aim of this study is to determine the absolute contraindication for hepatic resection for colorectal metastases and investigate the value of hepatectomy for gastric metastases by comparing it with the results of colorectal metastases performed with the same criteria.
A retrospective cohort study was conducted in patients undergoing hepatic resection for metastatic colorectal (n = 64) and gastric (n = 17) carcinomas. Common predictive factors for both metastases were analyzed by the stratified Cox proportional hazard model. In this model, the different baseline hazard was set for each disease, whereas the risk of each covariate was assumed to be equal in both gastric and colorectal metastases.
Overall 1-, 2-, and 5-yr survival rates after hepatectomy for colorectal and gastric metastases were 90%, 73%, 42%, and 47%, 22%, 0%, respectively. Factors controlling prognosis were as follows: age > or = 60, extrahepatic metastases, serosal invasion, grade of lymph node metastases, tumor cell differentiation of the primary lesion(s), carcinoembryonic antigen level, tumor-exposed surgical margin, and blood transfusion. In particular, presence of extrahepatic metastases showed the markedly high-risk ratio among these eight variables.
Hepatectomy, if possible, is indicated in patients with hepatic metastases from colorectal carcinoma if there are no extrahepatic metastases and if the primary disease is controlled. It is indicated only in carefully selected patients with metastases from gastric carcinoma.
本研究旨在确定结直肠癌肝转移肝切除的绝对禁忌证，并通过与按相同标准进行的结直肠癌转移结果相比较，探讨肝切除治疗胃癌转移的价值。
对接受肝切除治疗转移性结直肠癌（n = 64）和胃癌（n = 17）的患者进行回顾性队列研究。通过分层Cox比例风险模型分析两种转移的常见预测因素。在该模型中，为每种疾病设定不同的基线风险，而假定每个协变量在胃癌和结直肠癌转移中的风险相等。
结直肠癌和胃癌转移肝切除术后1年、2年和5年的总生存率分别为90%、73%、42%和47%、22%、0%。控制预后的因素如下：年龄≥60岁、肝外转移、浆膜侵犯、淋巴结转移分级、原发灶肿瘤细胞分化、癌胚抗原水平、肿瘤暴露手术切缘和输血。特别是，肝外转移的存在在这八个变量中显示出明显高的风险比。
如果可能，对于无肝外转移且原发疾病得到控制的结直肠癌肝转移患者，建议行肝切除。仅对经过仔细挑选的胃癌转移患者建议行肝切除。
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