Ivanecz Arpad, Potrc Stojan, Horvat Matjaz, Jagric Tomaz, Gadzijev Eldar
Department of Abdominal and General Surgery, University Medical Center-Maribor, Ljubljanska 5, 2000 Maribor, Slovenia. arpad.ivanecz@ukc-mb
Hepatogastroenterology. 2009 Sep-Oct;56(94-95):1452-8.
BACKGROUND/AIMS: The purpose of this study was to examine the validity of the clinical risk score (CRS) for a selection of patients for surgery.
In the period of January 1996 to June 2007, 169 patients underwent their first surgical and/or local ablative therapy for CRLM. This study assesses five preoperative prognostic criteria which define the CRS (nodal status of the primary tumor, the disease-free interval, the number of hepatic metastases, the preoperative CEA level, and the size of the largest metastasis). In the present study was analyzed the calculated CRS with respect to patient's postoperative survival.
An individual CRS was found to be predictive of survival. CRS stratified into two groups (CRS scores 0-2 and 3-5) were also found to be predictive of survival, with 5-year survival rates of 41% and 13%, respectively. CRS stratified into three groups (CRS scores 0-1; 2-3 and 4-5) were found predictive of survival as well, with 5-year survival rates of 72.7%, 21% and 4.6%, respectively.
Immediate hepatic resection is reasonable in patients with CRS 0 to 1. In patients with CRS 2 to 3, chemotherapy may be required in addition to hepatic resection. In patients with CRS 4 to 5, hepatic resection is probably reasonable only if there is a response to chemotherapy.
背景/目的：本研究旨在检验临床风险评分（CRS）在筛选手术患者方面的有效性。
在1996年1月至2007年6月期间，169例患者接受了首次针对结直肠癌肝转移（CRLM）的手术和/或局部消融治疗。本研究评估了定义CRS的五个术前预后标准（原发肿瘤的淋巴结状态、无病间期、肝转移灶数量、术前癌胚抗原（CEA）水平以及最大转移灶的大小）。在本研究中，分析了计算得出的CRS与患者术后生存率的关系。
发现个体CRS可预测生存率。CRS分为两组（CRS评分0 - 2和3 - 5）时也可预测生存率，5年生存率分别为41%和13%。CRS分为三组（CRS评分0 - 1；2 - 3和4 - 5）时同样可预测生存率，5年生存率分别为72.7%、21%和4.6%。
CRS为0至1的患者立即进行肝切除是合理的。CRS为2至3的患者，除肝切除外可能还需要化疗。CRS为4至5的患者，仅在对化疗有反应时肝切除可能才合理。
