Sasaki Atsushi, Iwashita Yukio, Shibata Kohei, Matsumoto Toshifumi, Ohta Masayuki, Kitano Seigo
Department of Surgery I, Oita University Faculty of Medicine, Oita 879-5593, Japan.
J Gastrointest Surg. 2005 Mar;9(3):374-80. doi: 10.1016/j.gassur.2004.09.031.
Hepatic resection is the most effective therapy for liver metastasis of colorectal carcinoma. To clarify indications for this therapy, the clinicopathologic and follow-up data of 103 consecutive patients who underwent hepatic resection for metastases of colorectal carcinoma were analyzed. Factors influencing overall survival rate were investigated by multivariate analysis. Thereafter, patients who underwent resection were stratified according to the number of independent risk factors present, and their outcomes were compared with those of 14 nonresection patients with fewer than six liver tumors and without extrahepatic metastasis. The overall survival rate of the 103 resection patients was 43.1%. The clinicopathologic factors shown to affect on long-term survival after hepatic resection were the interval between colorectal and hepatic surgery (<12 months), preoperative carcinoembryonic antigen level (> or =10 ng/ml), and number of hepatic metastases (four or more). The 5-year overall survival rates were 75.0% with no risk factors (n=16), 53.6% with one risk factor (n=46), 23.0% with two risk factors (n=36), and 0% with three risk factors (n=5). Survival rates did not differ between resection patients with three risk factors and nonresection patients. Therefore, hepatic resection may be appropriate for patients with fewer than three risk factors.
肝切除是治疗结直肠癌肝转移最有效的方法。为明确该治疗方法的适应证，对103例因结直肠癌肝转移而接受肝切除的连续患者的临床病理及随访资料进行了分析。通过多因素分析研究影响总生存率的因素。此后，根据存在的独立危险因素数量对接受肝切除的患者进行分层，并将其结果与14例肝肿瘤少于6个且无肝外转移的未接受肝切除患者的结果进行比较。103例接受肝切除患者的总生存率为43.1%。显示影响肝切除术后长期生存的临床病理因素为结直肠癌与肝手术的间隔时间（<12个月）、术前癌胚抗原水平（≥10 ng/ml）以及肝转移灶数量（4个或更多）。无危险因素（n = 16）患者的5年总生存率为75.0%，有1个危险因素（n = 46）患者为53.6%，有2个危险因素（n = 36）患者为23.0%，有3个危险因素（n = 5）患者为0%。有3个危险因素的肝切除患者与未接受肝切除患者之间的生存率无差异。因此，对于危险因素少于3个的患者，肝切除可能是合适的。
