Esposito A, Mancini R, Ettorre G, Garufi C, Saracca E, Arcieri S, Cosimelli M
Colorectal Cancer Project, Department of Surgery, Regina Elena Cancer Institute, Rome, Italy.
J Exp Clin Cancer Res. 2003 Dec;22(4 Suppl):197-202.
Hepatic metastases represent one of major clinical problems in patients affected by solid tumours because liver is the first site of metastatic disease after lymph nodes, (1, 2). The most common origins among adults are from colon and rectum cancer followed by pancreas (adenocarcinoma or neuroendocrine), lung and breast (3-7). It is estimated that in 15-20% of patients affected by adenocarcinoma of colon-rectum liver metastases are present at the time of diagnosis (8-11), while in 40% of cases they will develop during the follow-up (10, 11). Liver metastases are the first determinant for survival (1, 3, 12-17), and both hepatic and extrahepatic involvement have a statistical significant impact on it (3, 14, 18-21). Prognosis of patients affected by untreated disease is very poor, being 5 to 14 months with rare 2-year survivors and a 5-year survival rate of 0% (10, 21-24). In half of all patients affected by colorectal cancer and undergoing to a radical surgery, disease will fail in the liver (8, 25-28); among patients dying for colorectal cancer, 60-70% have a liver involvement (9, 29), and in 20-25% liver is the only site of recurrence and death results from liver failure (3, 29-31). In Autoptic studies those rates increased up to 83% and 38% respectively (1, 10, 17, 32).
肝转移是实体瘤患者面临的主要临床问题之一，因为肝脏是继淋巴结之后转移性疾病的首个发生部位（参考文献1, 2）。成年人中最常见的转移起源是结肠癌和直肠癌，其次是胰腺（腺癌或神经内分泌癌）、肺癌和乳腺癌（参考文献3 - 7）。据估计，15% - 20%的结直肠癌腺癌患者在诊断时就已出现肝转移（参考文献8 - 11），而在40%的病例中，肝转移会在随访期间发生（参考文献10, 11）。肝转移是生存的首要决定因素（参考文献1, 3, 12 - 17），肝内和肝外受累情况均对生存有统计学显著影响（参考文献3, 14, 18 - 21）。未经治疗的患者预后很差，生存期为5至14个月，很少有患者能存活2年，5年生存率为0%（参考文献10, 21 - 24）。在所有接受根治性手术的结直肠癌患者中，有一半患者的疾病会在肝脏复发（参考文献8, 25 - 28）；在死于结直肠癌的患者中，60% - 70%有肝脏受累（参考文献9, 29），20% - 25%的患者肝脏是唯一的复发部位，死亡原因是肝功能衰竭（参考文献3, 29 - 31）。在尸检研究中，这些比例分别升至83%和38%（参考文献1, 10, 17, 32）。
