Lee Won-Suk, Kim Min Jung, Yun Seong Hyeon, Chun Ho-Kyung, Lee Woo Yong, Kim Sung-Joo, Choi Seong-Ho, Heo Jin-Seok, Joh Jae Won, Kim Yong Il
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, South Korea.
Langenbecks Arch Surg. 2008 Jan;393(1):13-9. doi: 10.1007/s00423-007-0231-0. Epub 2007 Oct 2.
BACKGROUND/AIM: This study was conducted to devise a prognostic model for patients undergoing simultaneous liver and colorectal resection.
A retrospective analysis was performed on 138 colorectal patients who underwent simultaneous liver and colorectal resection between September 1994 and September 2005. The primary endpoint of the study was overall survival. Three patients with positive liver resection margin were excluded from the analysis.
At multivariate level, poor prognostic factors were liver resection margin < or =5 mm (P = 0.047; relative risk, 1.684; 95% CI = 1.010-2.809), CEA greater than 5 ng/ml (P = <0.001; relative risk, 2.507; 95% CI = 1.499-4.194), number of liver metastasis > 1 (P = <0.042; relative risk, 1.687; 95% CI = 1.020-2.789), and lymph node > or = 4 (P = <0.012; relative risk, 1.968; 95% CI = 1.158-3.347). The risk stratification grouping of the 135 patients was performed according to the following criteria: low risk group, 0-1 factor; intermediate risk group, 2 factors; high-risk group, 3-4 factors. Of 135 patients, 86 patients (63.0%) were categorized as low-risk group, 36 patients (26.6%) as intermediate risk group, and 14 patients (10.4%) as high-risk group. Median survival times for low, intermediate, high-risk groups were 68.0, 43.6 (95% CI, 24.7-62.4), and 23.5 months (95% CI, 9.4-31.5), respectively. The high-risk group demonstrated an approximately threefold (relative risk, 3.1; 95% CI, 1.6-6.0) increased risk of death.
A simple risk factor stratification system was proposed to evaluate the chances of cure of patients after simultaneous resection of liver metastases and primary colorectal carcinoma. The risk factor stratification showed three groups with distinct survival. The risk stratification may help to predict patient survival after simultaneous liver and colorectal resection. This system needs further prospective validation.
背景/目的：本研究旨在为同时接受肝脏和结直肠癌切除术的患者设计一种预后模型。
对1994年9月至2005年9月期间138例行同时肝脏和结直肠癌切除术的结直肠癌患者进行回顾性分析。本研究的主要终点是总生存期。3例肝切除切缘阳性的患者被排除在分析之外。
在多变量分析中，预后不良因素包括肝切除切缘≤5mm（P = 0.047；相对风险，1.684；95%可信区间 = 1.010 - 2.809）、癌胚抗原大于5ng/ml（P = <0.001；相对风险，2.507；95%可信区间 = 1.499 - 4.194）、肝转移灶数量>1（P = <0.042；相对风险，1.687；95%可信区间 = 1.020 - 2.789）以及淋巴结≥4个（P = <0.012；相对风险，1.968；95%可信区间 = 1.158 - 3.347）。根据以下标准对135例患者进行风险分层分组：低风险组，0 - 1个因素；中风险组，2个因素；高风险组，3 - 4个因素。135例患者中，86例（63.0%）被归类为低风险组，36例（26.6%）为中风险组，14例（10.4%）为高风险组。低、中、高风险组的中位生存期分别为68.0、43.6（95%可信区间，24.7 - 62.4）和23.5个月（95%可信区间，9.4 - 31.5）。高风险组的死亡风险增加了约三倍（相对风险，3.1；95%可信区间，1.6 - 6.0）。
提出了一种简单的风险因素分层系统，以评估肝转移灶和原发性结直肠癌同时切除术后患者的治愈机会。风险因素分层显示出三组具有明显不同的生存期。风险分层可能有助于预测同时进行肝脏和结直肠癌切除术后患者的生存情况。该系统需要进一步的前瞻性验证。
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