Lemke Johannes, Cammerer Gregor, Ganser Johannes, Scheele Jan, Xu Pengfei, Sander Silvia, Henne-Bruns Doris, Kornmann Marko
Clinic of General and Visceral Surgery, University of Ulm, Ulm, Germany.
Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany.
Clin Colorectal Cancer. 2016 Dec;15(4):e183-e192. doi: 10.1016/j.clcc.2016.04.007. Epub 2016 May 7.
Colorectal cancer is one leading cause of cancer-related death worldwide, and distant metastases determine an unfavorable prognosis. Surgical resection of colorectal liver metastases (CRLM) improves survival and provides the chance for cure. The aim of this study was to prospectively analyze the outcome of patients with CRLM in a population-based manner, and thereby, to compare the prognosis of patients undergoing resection with those receiving nonsurgical treatment. Moreover, we set out to identify and confirm important prognostic factors after resection of CRLM.
We analyzed the outcome of 506 patients diagnosed with CRLM in our institution from 1996 to 2011. Survival and the impact of clinical and pathologic factors were analyzed by univariate analysis. Important independent prognostic factors were analyzed by multivariate analysis.
The 5-year overall survival rate (5y-OSR) for patients receiving resection of CRLM (n = 152) was 46% (95% confidence interval (CI), 37%-54%) compared with a 5y-OSR of 6% (95% CI, 4%-9%) for patients treated nonsurgically (n = 354). There was no perioperative mortality. Multivariate analysis revealed, among other factors, good performance status of the patient (low American Society of Anesthesiologists score), the absence of extrahepatic metastases, < 5 metastatic lesions, and a tumor-free resection margin (R0) as important, independent prognostic factors. Importantly, repeated hepatic resections of CRLM performed in 13 patients were associated with an excellent outcome (5y-OSR, 47%; 95% CI, 17%-72%).
Surgical resection, which can be performed with tolerable site-effects, is the first choice for patients diagnosed with metachronous and synchronous CRLM. Of note, repeated resections should be advised in recurrent intrahepatic colorectal cancer whenever possible.
结直肠癌是全球癌症相关死亡的主要原因之一，远处转移决定了预后不良。结直肠癌肝转移（CRLM）的手术切除可提高生存率并提供治愈机会。本研究的目的是以人群为基础前瞻性分析CRLM患者的预后，从而比较接受手术切除患者与接受非手术治疗患者的预后。此外，我们着手识别并确认CRLM切除术后的重要预后因素。
我们分析了1996年至2011年在我院诊断为CRLM的506例患者的预后。通过单因素分析生存情况以及临床和病理因素的影响。通过多因素分析重要的独立预后因素。
接受CRLM切除的患者（n = 152）的5年总生存率（5y-OSR）为46%（95%置信区间（CI），37%-54%），而接受非手术治疗的患者（n = 354）的5y-OSR为6%（95%CI，4%-9%）。无围手术期死亡。多因素分析显示，除其他因素外，患者良好的身体状况（低美国麻醉医师协会评分）、无肝外转移、<5个转移灶以及切缘无肿瘤（R0）是重要的独立预后因素。重要的是，13例患者接受的CRLM重复肝切除术与良好的预后相关（5y-OSR，47%；95%CI，17%-72%）。
手术切除可在可耐受的副作用下进行，是诊断为异时性和同时性CRLM患者的首选。值得注意的是，对于复发性肝内结直肠癌，应尽可能建议重复切除。
