Mancini R, Ettorre G, Vennarecci G, Sperduti I, Garufi C, Esposito A, Cosimelli M
Colorectal Cancer Project, Department of Surgery, Regina Elena Cancer Institute, Rome, Italy.
J Exp Clin Cancer Res. 2003 Dec;22(4 Suppl):213-7.
Diagnosed colorectal cancer patients presents liver metastases at presentation in 25% of cases, an another 25% of patients will develop hepatic recurrence during follow-up period. Natural history of disease in untreated patients is sad without long term survivors. The only chance of curative treatment is surgical resection. Aim of this study was to evaluate recurrence and survival in the multimodal approach of colorectal liver metastases patients.
From 1990 to 2003, 212 colorectal cancer liver metastases patients were observed at the "Regina Elena" cancer institute of Rome, the 48.8% of cases were synchronous. Of 185 patients with minimum follow-up of 12 months, 80 were surgically resected, while 105 were not. Major resection was possible in 45.3% of cases and 66.1% of them were radicals. Tweny were treated by surgery alone, 65% were resected after i.v. chemotherapy, in the last 10% resection followed HAI chemotherapy. Of non resected patients, in the 36.2% i.v. chemotherapy was administered, 26.1% were submitted to HAI chemotherapy, in 18.9% others treatments were carried out and 18.8 were untreated.
Operative mortality was contained to 2.5%. The hepatic recurrence was observed in 50.5% of cases while extrahepatic was in the 13.6%. In the resected cases the 5-yr. Overall survival was 38.8%, the disease-free survival decreased to 14.7% with a median time to progression of 15 months. The liver recurrence-free survival was 31.3%. Really bad prognopsis was observed in the non resected patients with none survived at 5 years and 3-yr overall survival of 18.7%.
In selected patients the multimodality approach to treatment of hepatic metastases showed satisfactory results in terms of local and distal control of disease. Long term survivors were observed in the our experience.
确诊的结直肠癌患者中，25%在初诊时即出现肝转移，另有25%的患者在随访期间会发生肝复发。未经治疗的患者疾病自然史不佳，无长期存活者。治愈性治疗的唯一机会是手术切除。本研究的目的是评估结直肠癌肝转移患者多模式治疗中的复发情况和生存率。
1990年至2003年，罗马“雷吉娜·埃琳娜”癌症研究所观察了212例结直肠癌肝转移患者，48.8%的病例为同时性转移。在185例至少随访12个月的患者中，80例行手术切除，105例未手术。45.3%的病例可行大手术切除，其中66.1%为根治性切除。20例仅接受手术治疗，65%在静脉化疗后切除，最后10%在肝动脉灌注化疗后切除。在未切除的患者中，36.2%接受静脉化疗，26.1%接受肝动脉灌注化疗，18.9%接受其他治疗，18.8%未接受治疗。
手术死亡率控制在2.5%。50.5%的病例观察到肝复发，肝外复发为13.6%。在切除病例中，5年总生存率为38.8%，无病生存率降至14.7%，中位进展时间为15个月。无肝复发生存率为31.3%。未切除患者的预后很差，5年无一存活，3年总生存率为18.7%。
在选定的患者中，肝转移的多模式治疗在疾病的局部和远处控制方面显示出令人满意的结果。根据我们的经验观察到了长期存活者。
