Steele G, Bleday R, Mayer R J, Lindblad A, Petrelli N, Weaver D
Department of Surgery, New England Deaconess Hospital, Boston, MA.
J Clin Oncol. 1991 Jul;9(7):1105-12. doi: 10.1200/JCO.1991.9.7.1105.
We report here the results of the first multiinstitutional prospective evaluation of patients considered to have potentially resectable hepatic metastases from colorectal carcinoma. One hundred fifty-six patients were enrolled from 15 institutions. Six patients were subsequently excluded. One hundred fifty patients underwent surgery and are evaluable for analysis (median follow-up time, 3.1 years; range, 4 months to 5.1 years). Curative resection could be performed on 46% of patients (69 of 150), noncurative resection on 12% (18 of 150), while 42% were found to be unresectable (63 of 150). Thirty-day surgical mortality and morbidity rates in patients with attempted resection were 2.7% and 13%, respectively. The curative resection group was observed to have an improved median survival (37.1 months) compared with the noncurative resection group (21.2 months) and the unresectable group (16.5 months) (P less than .01). Computed tomographic (CT) scan was a poor predictor for resectability, and age was not a contraindication to curative resection. Preoperative carcinoembryonic antigen (CEA) values were also a poor predictor for resectability. However, the median CEA value 61 to 180 days postsurgery was significantly higher in unresectable patients compared with median CEA levels in noncuratively and curatively resected groups (P less than .01). Our results imply that curative resection leads to an increase in median survival. Noncurative resection provides no benefit to asymptomatic patients, since unresectable and noncurative resection groups have similar life expectancies. Longer follow-up will be needed to demonstrate the ultimate impact of curative resection on survival.
我们在此报告对被认为有可能切除的结直肠癌肝转移患者进行的首次多机构前瞻性评估结果。15家机构共纳入156例患者。随后排除6例患者。150例患者接受了手术，可进行分析评估（中位随访时间3.1年；范围4个月至5.1年）。46%的患者（150例中的69例）可进行根治性切除，12%（150例中的18例）进行了非根治性切除，而42%（150例中的63例）被发现无法切除。尝试切除患者的30天手术死亡率和发病率分别为2.7%和13%。与非根治性切除组（21.2个月）和无法切除组（16.5个月）相比，根治性切除组的中位生存期有所改善（37.1个月）（P<0.01）。计算机断层扫描（CT）对可切除性的预测效果不佳，年龄并非根治性切除的禁忌证。术前癌胚抗原（CEA）值对可切除性的预测也较差。然而，与非根治性切除组和根治性切除组的中位CEA水平相比，无法切除患者术后61至180天的中位CEA值显著更高（P<0.01）。我们的结果表明，根治性切除可提高中位生存期。非根治性切除对无症状患者无益处，因为无法切除组和非根治性切除组的预期寿命相似。需要更长时间的随访来证明根治性切除对生存的最终影响。
