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肝非结直肠、非神经内分泌、非肉瘤转移瘤:肝切除术作为姑息治疗中一种有前途的手段。

Non-colorectal, non-neuroendocrine, and non-sarcoma metastases of the liver: resection as a promising tool in the palliative management.

机构信息

Department of Surgery, University Hospital Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany.

出版信息

Langenbecks Arch Surg. 2010 Mar;395(3):227-34. doi: 10.1007/s00423-009-0580-y. Epub 2009 Dec 9.

Abstract

PURPOSE

Hepatic resection is established as a safe procedure for colorectal, neuroendocrine, and sarcoma liver metastases. The present study evaluates whether liver resection is an option for patients with non-colorectal, non-neuroendocrine, and non-sarcoma metastases of the liver.

METHODS

According to data from our prospective clinical tumor registry, we reviewed the medical records of 44 consecutive patients with non-colorectal, non-neuroendocrine, and non-sarcoma liver metastases, who underwent hepatic resection from January 2000 to December 2008. Univariate Kaplan-Meier analysis and a stepwise multivariable Cox regression model were applied.

RESULTS

Following hepatic resection, mean overall survival was 21 months, and 5-year survival was 20%. Following hepatic resection, gender, histology, and chemotherapy were of prognostic value in our patient cohort in univariate analysis (p < 0.05). Multivariate survival analysis confirmed chemotherapy (p = 0.002) as an independent prognostic variable. Following initial resection of the primary tumor, synchrone occurrence of metastases, histology, localization of primary, perioperative complications, interval between initial resection of the primary tumor and resection of the metastases, and metastases in follow-up after hepatic resection were of prognostic value in univariate analysis (p < 0.05). Histology (p = 0.017) and interval between resection of the primary and resection of the metastases (p = 0.030) were confirmed as independent prognostic variables in multivariate survival analysis.

CONCLUSIONS

Hepatic resection seems to be a safe and promising additive for a selective group of patients with non-colorectal, non-neuroendocrine, and non-sarcoma metastases of the liver.

摘要

目的

肝切除术已被确立为结直肠、神经内分泌和肉瘤肝转移的安全治疗方法。本研究旨在评估肝切除术是否适用于非结直肠、非神经内分泌和非肉瘤肝转移患者。

方法

根据前瞻性临床肿瘤登记数据,我们回顾了 2000 年 1 月至 2008 年 12 月期间 44 例连续非结直肠、非神经内分泌和非肉瘤肝转移患者的病历。采用单因素 Kaplan-Meier 分析和逐步多因素 Cox 回归模型。

结果

肝切除术后,总生存期平均为 21 个月,5 年生存率为 20%。肝切除术后,性别、组织学和化疗在单因素分析中对我们的患者队列具有预后价值(p<0.05)。多因素生存分析证实化疗(p=0.002)是独立的预后变量。在初始原发肿瘤切除后,转移的同步发生、组织学、原发肿瘤的定位、围手术期并发症、原发肿瘤切除与转移切除之间的间隔以及肝切除后随访中的转移是单因素分析中的预后因素(p<0.05)。组织学(p=0.017)和原发肿瘤切除与转移切除之间的间隔(p=0.030)在多因素生存分析中被确认为独立的预后因素。

结论

肝切除术似乎是一组选择性非结直肠、非神经内分泌和非肉瘤肝转移患者的安全且有希望的治疗方法。

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