肿瘤沉积是同时行结直肠肝转移灶切除患者的预后不良指标。
Tumor deposit is a poor prognostic indicator in patients who underwent simultaneous resection for synchronous colorectal liver metastases.
机构信息
Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
出版信息
Onco Targets Ther. 2015 Jan 22;8:233-40. doi: 10.2147/OTT.S71414. eCollection 2015.
BACKGROUND
Tumor deposits are one of the important influencing factors among the different editions of Tumor, Node, Metastasis classification. Incidence and prognosis of tumor deposits in stage I, II, and III colorectal cancer patients has been explored. The aim of this study was to determine the prognostic value of tumor deposits in stage IV colorectal cancer patients who underwent simultaneous resection for synchronous colorectal liver metastases (SCRLM).
METHODS
Clinicopathological and outcome data of 146 consecutive SCRLM patients who underwent simultaneous R0 resection between July 2003 and July 2013 were collected from our prospectively established SCRLM database. The prognostic value of tumor deposits was evaluated by Kaplan-Meier and Cox regression analysis.
RESULTS
Tumor deposits were detected in 41.8% (61/146) of these SCRLM patients. Tumor deposits were significantly correlated with lymph node metastasis and nerve invasion of the primary tumors (P=0.002, P=0.041; respectively). The Kaplan-Meier survival analysis revealed that the overall survival (OS) and disease-free survival (DFS) of SCRLM patients with tumor deposits were significantly poorer than those with no tumor deposits (P=0.039, P=0.001; respectively). And with multivariate analysis, we found that positive tumor deposits were significantly associated with shorter DFS independent of lymph node status (P=0.002). Subgroup analysis found that of the 57 SCRLM patients with negative lymph node status, the OS and DFS of patients with positive tumor deposits were significantly shorter than those with negative tumor deposits (P=0.002 and P=0.031, respectively). Of the 89 patients with positive lymph node status, the OS of patients with tumor deposits was not significantly different than those without tumor deposits (P=0.965); however, the DFS of patients with tumor deposits was significantly shorter than those with no tumor deposits (P=0.034).
CONCLUSION
Tumor deposits may be an independent adverse prognostic factor in SCRLM patients who underwent simultaneous R0 resection.
背景
肿瘤沉积物是肿瘤、淋巴结、转移分类的不同版本中的一个重要影响因素。已经探讨了 I、II 和 III 期结直肠癌患者中肿瘤沉积物的发生率和预后。本研究的目的是确定同时接受结直肠肝转移同步切除术（SCRLM）的 IV 期结直肠癌患者中肿瘤沉积物的预后价值。
方法
从我们前瞻性建立的 SCRLM 数据库中收集了 2003 年 7 月至 2013 年 7 月期间接受同时行 R0 切除的 146 例连续 SCRLM 患者的临床病理和结果数据。通过 Kaplan-Meier 和 Cox 回归分析评估肿瘤沉积物的预后价值。
结果
在这些 SCRLM 患者中，有 41.8%（61/146）检测到肿瘤沉积物。肿瘤沉积物与原发肿瘤的淋巴结转移和神经浸润显著相关（P=0.002，P=0.041；分别）。Kaplan-Meier 生存分析显示，有肿瘤沉积物的 SCRLM 患者的总生存（OS）和无病生存（DFS）明显差于无肿瘤沉积物的患者（P=0.039，P=0.001；分别）。通过多变量分析，我们发现阳性肿瘤沉积物与DFS 较短独立相关，而与淋巴结状态无关（P=0.002）。亚组分析发现，在 57 例淋巴结状态阴性的 SCRLM 患者中，阳性肿瘤沉积物患者的 OS 和 DFS 明显短于阴性肿瘤沉积物患者（P=0.002 和 P=0.031；分别）。在 89 例淋巴结状态阳性的患者中，肿瘤沉积物患者的 OS 与无肿瘤沉积物患者无显著差异（P=0.965）；然而，肿瘤沉积物患者的 DFS 明显短于无肿瘤沉积物患者（P=0.034）。
结论
肿瘤沉积物可能是同时接受 R0 切除的 SCRLM 患者的一个独立的不良预后因素。
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