转移性结直肠癌肝切除经验：临床和病理危险因素分析
Experience in hepatic resection for metastatic colorectal cancer: analysis of clinical and pathologic risk factors.
作者信息
Gayowski T J, Iwatsuki S, Madariaga J R, Selby R, Todo S, Irish W, Starzl T E
机构信息
Department of Surgery, University of Pittsburgh Medical Center, Pa.
出版信息
Surgery. 1994 Oct;116(4):703-10; discussion 710-1.
BACKGROUND
The selection of patients for resective therapy of hepatic colorectal metastases remains controversial. A number of clinical and pathologic prognostic risk factors have been variably reported to influence survival.
METHODS
Between January 1981 and December 1991, 204 patients underwent curative hepatic resection for metastatic colorectal cancer. Fourteen clinical and pathologic determinants previously reported to influence outcome were examined retrospectively. This led to a proposed TNM staging system for metastatic colorectal cancer (mTNM).
RESULTS
No operative deaths occurred (death within 1 month). Overall 1-, 3-, and 5-year survivals were 91%, 43%, and 32%, respectively. Gender, Dukes' classification, site of primary colorectal cancer, histologic differentiation, size of metastatic tumor, and intraoperative blood transfusion requirement were not statistically significant prognostic factors (p > 0.05). Age of 60 years or more, interval of 24 months or less between colorectal and hepatic resection, four or more gross tumors, bilobar involvement, positive resection margin, lymph node involvement, and direct invasion to adjacent organs were significant poor prognostic factors (p < 0.05). In the absence of nodal disease or direct invasion, patients with unilobar solitary tumor of any size, or unilobar multiple tumors of 2 cm or smaller (stages I and II) had the highest survival rates of 93% at 1 year, 68% at 3 years, and 61% at 5 years. Unilobar disease with multiple lesions greater than 2 cm (stage III) resulted in 1-, 3-, and 5-year survivals of 98%, 45%, and 28%, respectively. Patients with bilobar involvement (multiple tumors, any size, or a single large metastasis) (stage IVA) had survival rates of 88% at 1 year, 28% at 3 years, and 20% at 5 years (p < 0.00001). Patients with nodal involvement or extrahepatic disease (stage IVB) experienced the poorest outcome with 1-, 3-, and 5-year survivals of 80%, 12%, and 0%, respectively (p < 0.00001).
CONCLUSIONS
The proposed mTNM staging system appears to be useful in predicting the outcomes after hepatic resection of metastatic colorectal tumors.
背景
对于肝转移结直肠癌患者选择切除性治疗仍存在争议。已有多项临床和病理预后危险因素被报道会不同程度地影响生存率。
方法
1981年1月至1991年12月期间，204例患者接受了转移性结直肠癌的根治性肝切除术。对先前报道的影响预后的14个临床和病理决定因素进行了回顾性研究。由此提出了一种转移性结直肠癌的TNM分期系统（mTNM）。
结果
无手术死亡（1个月内死亡）。总体1年、3年和5年生存率分别为91%、43%和32%。性别、Dukes分期、原发性结直肠癌部位、组织学分化、转移瘤大小和术中输血需求不是具有统计学意义的预后因素（p>0.05）。60岁及以上、结直肠癌与肝切除间隔24个月及以内、4个及以上大体肿瘤、双叶受累、切缘阳性、淋巴结受累以及直接侵犯相邻器官是显著的不良预后因素（p<0.05）。在无淋巴结疾病或直接侵犯的情况下，任何大小的单叶孤立肿瘤或直径2 cm及以下的单叶多发肿瘤患者（I期和II期）1年生存率最高，为93%，3年生存率为68%，5年生存率为61%。具有多个大于2 cm病变的单叶疾病（III期）1年、3年和5年生存率分别为98%、45%和28%。双叶受累患者（多个肿瘤，任何大小，或单个大转移灶）（IVA期）1年生存率为88%，3年生存率为28%，5年生存率为20%（p<0.00001）。有淋巴结受累或肝外疾病患者（IVB期）预后最差，1年、3年和5年生存率分别为80%、12%和0%（p<0.00001）。
结论
所提出的mTNM分期系统似乎有助于预测转移性结直肠癌肝切除术后的预后。
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