Holm A, Bradley E, Aldrete J S
Department of Surgery, University of Alabama School of Medicine, Birmingham.
Ann Surg. 1989 Apr;209(4):428-34. doi: 10.1097/00000658-198904000-00007.
To identify the factors that determine the morbidity and mortality of liver resection of metastases from colorectal carcinoma and the variables that may influence the pattern of recurrence, the survival time and the disease-free rate, a univariate and-multivariate statistical analysis (30 variables using Student's t-test, Fischer's exact test, and chi square test) was performed. Intraoperative blood loss of greater than 3500 ml was found to be a significant risk factor to developing postoperative complications (p less than 0.05 by x2). After a mean follow-up of 25.8 months, 26 of the 35 patients studied (74%) had recurrent disease. In the univariate analysis, the following factors appear to be reliable predictors of early recurrence: poor degree of differentiation of the primary colorectal tumor, the presence of multiple liver metastases, the male gender, and the presence of tumor at the margin of the resected hepatic tissue (p less than 0.05). However, only the latter two factors appeared also to affect the survival time and the disease-free rates at 2 years after hepatic resection of metastases (p less than 0.05). In the multivariate analysis (factors tested simultaneously), presence of an advanced liver metastatic disease (Stage II or III) consistently indicated early recurrence and poor survival (p less than 0.005). The liver was the most common site of recurrence as the sole site of recurrence (54%) or in combination with other sites (88%)--followed by the lungs (31%) and the site of colonic resection (8%). Twenty-nine (83%), 14 (40%), and nine (26%) patients survived without recurrent disease at 1, 2, and 3 or more years, respectively, after hepatic resection of metastases. In six patients (17%), no significant palliation was noted, primarily because of early recurrence (less than 6 months). From this data, resection of hepatic metastases from colorectal cancer appears to offer a realistic therapeutic option to a selected group of patients, but only if the resective procedure can be performed with an operative mortality rate of less than 5%.
为了确定决定结直肠癌肝转移灶肝切除发病率和死亡率的因素以及可能影响复发模式、生存时间和无病生存率的变量，进行了单因素和多因素统计分析（使用学生t检验、费舍尔精确检验和卡方检验分析30个变量）。术中失血超过3500毫升被发现是发生术后并发症的一个重要危险因素（经卡方检验p<0.05）。在平均随访25.8个月后，所研究的35例患者中有26例（74%）出现疾病复发。在单因素分析中，以下因素似乎是早期复发的可靠预测指标：原发性结直肠癌肿瘤分化程度差、存在多个肝转移灶、男性以及切除的肝组织边缘存在肿瘤（p<0.05）。然而，只有后两个因素似乎也影响肝转移灶切除术后2年的生存时间和无病生存率（p<0.05）。在多因素分析（同时检验多个因素）中，晚期肝转移疾病（II期或III期）的存在始终表明早期复发和生存不佳（p<0.005）。肝脏是最常见的复发部位，作为唯一的复发部位（54%）或与其他部位联合复发（88%），其次是肺（31%）和结肠切除部位（8%）。分别有29例（83%）、14例（40%）和9例（26%）患者在肝转移灶切除术后1年、2年和3年或更长时间无疾病复发存活。6例患者（17%）未观察到明显的病情缓解，主要原因是早期复发（不到6个月）。根据这些数据，结直肠癌肝转移灶的切除似乎为部分选定患者提供了一种现实的治疗选择，但前提是切除手术的手术死亡率低于5%。
