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[结直肠癌根治术后辅助性门静脉肝灌注的初步结果(瑞士癌症流行病学与临床研究组40/81研究)]

[Initial results of adjuvant portal liver infusion following radical surgery of colorectal cancer (Swiss Study Group for Epidemiologic and Clinical Cancer Research Study 40/81)].

作者信息

Metzger U, Laffer U, Egeli R, Barras J, Martinoli S, Müller W, Arma S, Bär H U, Schweizer W, Aeberhard P

出版信息

Helv Chir Acta. 1989 Dec;56(4):455-60.

PMID:2517282
Abstract

Between July 1981 and June 1987, 533 patients from 7 participating institutions have been entered in a prospective randomized trial to assess the value of adjuvant portal infusion (5-Fluorouracil 500 mg/m2/d x 7 continuous infusion + Mitomycin-C 10 mg/m2 on day 1 as a bolus injection through portal venous catheter) compared to radical surgery alone. The portal venous catheter was placed through any side-branch of the mesenteric venous system during laparotomy for the primary tumour. Using the transabdominal route, there have been no catheter-related complications. Overall hospital mortality in the study was 1.75% and was not influenced by adjuvant treatment. Analysis of 469 eligible patients at a median follow-up of 48 months revealed 39.1% recurrencies in the control group and 31.8% in the infusion group (p = 0.09, logrank). Median survival of control patients is 72 months, of chemotherapy treated patients not yet reached. Significant survival advantages have been detected for those 195 (85%) patients who received full-dose adjuvant chemotherapy (67% versus 53% 5-year survival). Due to the low number of deaths in this trial, prolonged follow-up is needed for definitive survival conclusions.

摘要

1981年7月至1987年6月期间,来自7个参与机构的533名患者进入了一项前瞻性随机试验,以评估辅助门静脉输注(5-氟尿嘧啶500mg/m²/天,持续输注7天+丝裂霉素-C 10mg/m²,于第1天通过门静脉导管进行大剂量注射)与单纯根治性手术相比的价值。门静脉导管在剖腹手术切除原发性肿瘤时,通过肠系膜静脉系统的任何一个侧支放置。采用经腹途径,未出现与导管相关的并发症。该研究中的总体医院死亡率为1.75%,且不受辅助治疗的影响。对469例符合条件的患者进行分析,中位随访48个月,结果显示对照组复发率为39.1%,输注组为31.8%(p = 0.09,对数秩检验)。对照组患者的中位生存期为72个月,接受化疗患者的中位生存期尚未达到。在接受全剂量辅助化疗的195例(85%)患者中检测到显著的生存优势(5年生存率分别为67%和53%)。由于该试验中的死亡人数较少,需要延长随访时间才能得出明确的生存结论。

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