Kato Tomoyuki, Yasui Kenzo, Hirai Takashi, Kanemitsu Yukihide, Mori Takeo, Sugihara Kenichi, Mochizuki Hidetaka, Yamamoto Junji
Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan.
Dis Colon Rectum. 2003 Oct;46(10 Suppl):S22-31. doi: 10.1097/01.DCR.0000089106.71914.00.
Factors affecting treatment prognosis and therapeutic results for hepatic metastasis of colorectal cancer were investigated.
Therapeutic results, especially of hepatectomy, were investigated for hepatic metastasis of colorectal cancer in 763 patients (585 underwent hepatectomy) treated between 1992 and 1996 at 18 institutions that participated in the "Study for establishing treatments for hepatic and pulmonary metastasis of colorectal cancer" sponsored by a Grant-in-Aid (10-11) for Cancer Research from the Ministry of Health, Welfare and Labor of Japan.
The five-year survival rate for those treated by hepatectomy was significantly higher (32.9 percent) than for those not undergoing hepatectomy (3.4 percent). After hepatectomy for hepatic metastasis, the most prevalent form of recurrence was in the remnant liver (41.4 percent), followed by recurrence of pulmonary metastasis (19.2 percent), and other (7.2 percent). Factors of the primary tumor adversely affecting prognosis after hepatectomy for hepatic metastasis included poorly differentiated adenocarcinoma or mucinous carcinoma, depth of invasion of si/ai, lymph-node metastasis of Stage n3 and n4 by the Japanese classification of colorectal carcinoma, number of metastatic lymph nodes of more than four, and Dukes Stage D. Factors at the time of hepatectomy adversely affecting prognosis after surgery for hepatic metastasis included residual tumor, extrahepatic metastasis, hepatic metastasis of degree H3 stipulated by the Japanese classification of colorectal carcinoma, number of metastases of four or more, pathology of hepatic metastasis of poorly differentiated adenocarcinoma, resection margin of <10 mm, and carcinoembryonic antigen value higher than normal preoperative and one month postoperative.
Among therapies for hepatic metastasis of colorectal cancer, the present study clearly revealed that hepatectomy is the treatment of choice whenever feasible. Postoperative recurrence often is localized in the remnant liver, or there may be a systemic recurrence of pulmonary metastasis. Thus, methods of prevention will be a future theme.
研究影响结直肠癌肝转移治疗预后和治疗效果的因素。
对1992年至1996年期间在18家机构接受治疗的763例结直肠癌肝转移患者（585例行肝切除术）的治疗效果，尤其是肝切除术的效果进行了研究。这些机构参与了由日本厚生劳动省癌症研究资助（10 - 11）发起的“结直肠癌肝肺转移治疗方法的研究”。
接受肝切除术患者的五年生存率（32.9%）显著高于未接受肝切除术的患者（3.4%）。肝转移灶切除术后，最常见的复发形式是残肝复发（41.4%），其次是肺转移复发（19.2%），其他部位复发（7.2%）。结直肠癌肝转移灶切除术后对预后产生不利影响的原发肿瘤因素包括低分化腺癌或黏液腺癌、si/ai浸润深度、按照日本结直肠癌分类法属于n3和n4期的淋巴结转移、转移淋巴结数超过4个以及Dukes D期。肝转移灶切除术后对预后产生不利影响的手术时因素包括残留肿瘤、肝外转移、按照日本结直肠癌分类法规定的H3级肝转移、转移灶数4个或更多、低分化腺癌肝转移的病理类型、切除切缘<10 mm以及癌胚抗原值高于术前及术后1个月正常水平。
在结直肠癌肝转移的治疗方法中，本研究明确表明，只要可行，肝切除术是首选治疗方法。术后复发常局限于残肝，或者可能出现肺转移的全身复发。因此，预防方法将是未来的研究主题。
