Department of General, Visceral and Vascular Surgery, University Hospital Jena, Erlanger Allee 101, Jena, 07740, Germany.
Int J Colorectal Dis. 2011 Aug;26(8):967-81. doi: 10.1007/s00384-011-1195-7. Epub 2011 May 17.
Prognosis after resection of liver metastases of colorectal cancer is influenced by a variety of clinical factors. For more than 20 years, efforts have been made to restructure and simplify prognostic parameters into clinical scores. We evaluated the influence of various clinical and pathological factors on survival and recurrence and developed a simple model for risk stratification.
We have analyzed a total of 13 prognostic factors in 382 consecutive and prospectively enrolled R0-resected patients and applied our data set to ten published prognostic scoring systems. Prognostic factors that influenced disease-specific and disease-free survival were included into a model clinical risk score.
The 5- and 10-year observed survival rates were 43% and 28%, respectively, for all 382 patients. The disease-specific 5- and 10-year survival rates were 49% and 37%, respectively; the 5- and 10-year recurrence rates were 68% and 70%, respectively. For patients with synchronous liver metastases, survival was not affected by the timing of liver resection. The prognosis after treatment of any recurrence was best after the accomplishment of a repeated R0 situation, independent of the location of the recurrence. In the multivariate analysis, the disease-specific survival and recurrence rates were statistically significantly influenced by more than three lymph node metastases of the primary tumor, more than two lesions within the liver, and the presence of extrahepatic tumor.
From these data, we have developed a simple score for the risk stratification which may be useful for future studies on interdisciplinary management of colorectal liver metastases.
结直肠癌肝转移切除术后的预后受多种临床因素的影响。20 多年来，人们一直致力于将预后参数重构和简化为临床评分。我们评估了各种临床和病理因素对生存和复发的影响，并建立了一种简单的风险分层模型。
我们分析了 382 例连续前瞻性 R0 切除患者的 13 个预后因素，并将我们的数据应用于 10 个已发表的预后评分系统。将影响疾病特异性和无病生存的预后因素纳入模型临床风险评分。
所有 382 例患者的 5 年和 10 年观察生存率分别为 43%和 28%。疾病特异性 5 年和 10 年生存率分别为 49%和 37%；5 年和 10 年复发率分别为 68%和 70%。对于同步肝转移患者，肝切除术的时机并不影响生存。任何复发后的治疗预后最好是在实现重复 R0 情况下，与复发部位无关。多因素分析显示，肿瘤原发灶淋巴结转移超过 3 个、肝内病灶超过 2 个和肝外肿瘤存在对疾病特异性生存和复发率有统计学显著影响。
根据这些数据，我们制定了一种简单的风险分层评分，这可能对结直肠肝转移的跨学科管理的未来研究有用。
