Rees Myrddin, Tekkis Paris P, Welsh Fenella K S, O'Rourke Thomas, John Timothy G
Department of Hepatobiliary Surgery, North Hampshire Hospital, Aldermaston Road, Basingstoke, Hampshire, United Kingdom.
Ann Surg. 2008 Jan;247(1):125-35. doi: 10.1097/SLA.0b013e31815aa2c2.
To identify risk factors associated with cancer-specific survival and develop a predictive model for patients undergoing primary hepatic resection for metastatic colorectal cancer.
No published studies investigated collectively the inter-relation of factors related to patient cancer-specific survival after hepatectomy for metastatic colorectal cancer.
Clinical, pathologic, and complete follow-up data were prospectively collected from 929 consecutive patients undergoing primary (n = 925) or repeat hepatic resection (n = 80) for colorectal liver metastases at a tertiary referral center from 1987 to 2005. Parametric survival analysis was used to identify predictors of cancer-specific survival and develop a predictive model. The model was validated using measures of discrimination and calibration.
Postoperative mortality and morbidity were 1.5% and 25.9%, respectively. 5-year and 10-year cancer-specific survival were 36% and 23%. On multivariate analysis, 7 risk factors were found to be independent predictors of poor survival: number of hepatic metastases >3, node positive primary, poorly differentiated primary, extrahepatic disease, tumor diameter > or =5 cm, carcinoembryonic antigen level >60 ng/mL, and positive resection margin. The first 6 of these criteria were used in a preoperative scoring system and the last 6 in the postoperative setting. Patients with the worst postoperative prognostic criteria had an expected median cancer-specific survival of 0.7 years and a 5-year cancer-specific survival of 2%. Conversely, patients with the best prognostic postoperative criteria had an expected median cancer-specific survival of 7.4 years and a 5-year cancer-specific survival of 64%. When tested both predictive models fitted the data well with no significant differences between observed and predicted outcomes (P > 0.05).
Resection of liver metastases provides good long-term cancer-specific survival benefit, which can be quantified pre- or postoperatively using the criteria described. The "Basingstoke Predictive Index" may be used for risk-stratifying patients who may benefit from intensive surveillance and selection for adjuvant therapy and trials.
确定与癌症特异性生存相关的危险因素，并为接受转移性结直肠癌肝切除术的患者建立预测模型。
尚无已发表的研究综合调查转移性结直肠癌肝切除术后与患者癌症特异性生存相关因素之间的相互关系。
前瞻性收集了1987年至2005年在一家三级转诊中心连续接受原发性（n = 925）或再次肝切除术（n = 80）治疗结直肠癌肝转移的929例患者的临床、病理和完整随访数据。采用参数生存分析来确定癌症特异性生存的预测因素并建立预测模型。使用区分度和校准度指标对该模型进行验证。
术后死亡率和发病率分别为1.5%和25.9%。5年和10年癌症特异性生存率分别为36%和23%。多因素分析发现，7个危险因素是生存不良的独立预测因素：肝转移灶数量>3个、原发灶淋巴结阳性、原发灶分化差、肝外疾病、肿瘤直径≥5 cm、癌胚抗原水平>60 ng/mL以及手术切缘阳性。前6项标准用于术前评分系统，后6项用于术后情况。术后预后标准最差的患者预期癌症特异性生存中位数为0.7年，5年癌症特异性生存率为2%。相反，术后预后标准最佳的患者预期癌症特异性生存中位数为7.4年，5年癌症特异性生存率为64%。当对两个预测模型进行测试时，模型与数据拟合良好，观察结果与预测结果之间无显著差异（P>0.05）。
肝转移灶切除术可带来良好的长期癌症特异性生存获益，可使用所述标准在术前或术后进行量化。“贝辛斯托克预测指数”可用于对可能从强化监测及辅助治疗和试验选择中获益的患者进行风险分层。
