Han Eon Chul, Ryoo Seung-Bum, Park Ji Won, Yi Jin Wook, Oh Heung-Kwon, Choe Eun Kyung, Ha Heon-Kyun, Park Byung Kwan, Moon Sang Hui, Jeong Seung-Yong, Park Kyu Joo
Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea.
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
PLoS One. 2017 Jun 6;12(6):e0178920. doi: 10.1371/journal.pone.0178920. eCollection 2017.
The management of colorectal cancer in patients with liver cirrhosis requires a thorough understanding of both diseases. This study evaluated the effect of liver cirrhosis on oncologic and surgical outcomes and prognostic factors in colorectal cancer patients. Fifty-five consecutive colorectal cancer patients with liver cirrhosis underwent colorectal resection (LC group). Using a prospectively maintained database, these patients were matched 1:4 using propensity scoring with R programming language, package "MatchIt" and "optmatch" by sex, age, cancer location, and tumor stage with 220 patients without liver cirrhosis (non-LC group), resulting in 275 patients. The 5-year overall survival (OS) was significantly worse in the LC group than in the non-LC group (46.7% vs. 76.2% respectively, P < 0.001); however, the 5-year proportion of recurrence free (PRF) rates were similar (73.1% vs. 84.5% respectively, P = 0.094). On multivariate analysis of the LC group, tumor-node-metastasis (TNM) stage ≥III disease, venous invasion, and a model for end-stage liver disease plus serum sodium (MELD-Na) score >10 were prognostic factors for OS. However, the OS was not different between the LC group with MELD-Na score ≤10 and the non-LC group (5-year OS rate, TNM stage ≤II, 85.7 vs 89.5%, p = 0.356; TNM stage ≥III, 41.1 vs 66.2%, p = 0.061). Colorectal cancer patients with liver cirrhosis have poorer OS compared to those without liver cirrhosis; however, the PRF rates are similar. It might be due to the mortality from the liver, and surgical treatment should be actively considered for patients with MELD-Na score <10.
肝硬化患者的结直肠癌管理需要对这两种疾病有透彻的了解。本研究评估了肝硬化对结直肠癌患者肿瘤学和手术结局以及预后因素的影响。55例连续性肝硬化结直肠癌患者接受了结直肠切除术（LC组）。利用前瞻性维护的数据库，使用R编程语言、“MatchIt”和“optmatch”软件包，根据性别、年龄、癌症位置和肿瘤分期，通过倾向评分将这些患者与220例无肝硬化患者（非LC组）进行1:4匹配，最终纳入275例患者。LC组的5年总生存率（OS）显著低于非LC组（分别为46.7%和76.2%，P<0.001）；然而，5年无复发生存率（PRF）相似（分别为73.1%和84.5%，P = 0.094）。对LC组进行多因素分析，肿瘤-淋巴结-转移（TNM）分期≥III期疾病、静脉侵犯以及终末期肝病模型加血清钠（MELD-Na）评分>10是OS的预后因素。然而，MELD-Na评分≤10的LC组与非LC组的OS无差异（5年OS率，TNM分期≤II期，85.7%对89.5%，p = 0.356；TNM分期≥III期，41.1%对66.2%，p = 0.061）。与无肝硬化的结直肠癌患者相比，肝硬化结直肠癌患者的OS较差；然而，PRF率相似。这可能是由于肝脏原因导致的死亡，对于MELD-Na评分<10的患者应积极考虑手术治疗。
