Sasaki Atsushi, Iwashita Yukio, Shibata Kohei, Matsumoto Toshifumi, Ohta Masayuki, Inomata Masafumi, Kitano Seigo
Department of Surgery I, Oita University Faculty of Medicine, Japan.
Hepatogastroenterology. 2005 Nov-Dec;52(66):1840-4.
BACKGROUND/AIMS: Hepatic resection is one of the most effective therapies for colorectal liver metastasis. However, extrahepatic metastasis is frequently encountered within a short time postoperatively. We attempted to clarify the risk factors for extrahepatic metastasis in patients with colorectal liver metastasis.
We retrospectively analyzed data obtained from 116 consecutive patients with colorectal liver metastasis. To determine predictors of extrahepatic metastasis within 1 year of admission for treatment of colorectal liver, we examined 12 clinicopathologic factors by univariate and multivariate logistic regression analyses.
Eighty-five underwent hepatectomy and/or thermal ablation (hepatectomy group) and 31 underwent only chemotherapy (non-hepatectomy group). Thirty-one in the hepatectomy group and 19 in the non-hepatectomy group developed extrahepatic metastasis at 1 year after admission. Univariate analysis showed that treatment without hepatectomy and lymphatic vessel permeation at the primary site were significant predictive factors for extrahepatic metastasis within 1 year. Multivariate analysis showed lymphatic permeation of the primary tumor, and treatment without hepatectomy to be significantly related to the occurrence of extrahepatic metastasis within 1 year.
The two factors that we identified put patients with colorectal liver metastasis at high risk for extrahepatic metastasis. Systemic chemotherapy may be needed to prevent extrahepatic disease in such patients.
背景/目的：肝切除是治疗结直肠癌肝转移最有效的方法之一。然而，肝外转移在术后短时间内经常出现。我们试图阐明结直肠癌肝转移患者肝外转移的危险因素。
我们回顾性分析了116例连续的结直肠癌肝转移患者的数据。为了确定结直肠癌肝转移患者入院治疗1年内肝外转移的预测因素，我们通过单因素和多因素逻辑回归分析检查了12个临床病理因素。
85例行肝切除术和/或热消融术（肝切除组），31例仅接受化疗（非肝切除组）。肝切除组31例和非肝切除组19例在入院1年后发生肝外转移。单因素分析显示，未行肝切除术和原发部位淋巴管浸润是1年内肝外转移的重要预测因素。多因素分析显示，原发肿瘤的淋巴管浸润和未行肝切除术与1年内肝外转移的发生显著相关。
我们确定的这两个因素使结直肠癌肝转移患者发生肝外转移的风险很高。对于这类患者，可能需要全身化疗以预防肝外疾病。
