D'Angelica M, Brennan M F, Fortner J G, Cohen A M, Blumgart L H, Fong Y
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
J Am Coll Surg. 1997 Dec;185(6):554-9. doi: 10.1016/s1072-7515(97)00103-8.
Studies have consistently confirmed the benefit of liver resection for metastatic colorectal cancer. Few reports, however, have a long enough followup or sufficient 5-year survivors to study the clinical course of patients beyond 5 years.
From July 1985 through December 1991, 456 patients underwent liver resection for colorectal metastases. Ninety-six actual 5-year survivors (21%) were identified and their clinical course retrospectively reviewed.
Five-year survivors (n = 96) were more likely to have a Duke's B primary colorectal carcinoma, fewer than four metastatic lesions, unilobar disease, and a negative histologic margin when compared with patients not surviving 5 years (n = 298). Forty-four (46%) of the 96 five-year survivors had a recurrence after hepatectomy. Of these 44, 19 (43%) were rendered disease free after further treatment. Overall, 71 of the 96 five-year survivors were free of disease at last followup. The actuarial 10-year survival of this group was 78%.
Patients that are disease free 5 years after liver resection are likely to have been cured by liver resection. Patients should be aggressively followed for recurrence because of the potential for further treatment and longterm survival.
研究一致证实肝切除治疗转移性结直肠癌的益处。然而,很少有报告具有足够长的随访时间或足够数量的5年生存者来研究患者5年后的临床病程。
从1985年7月至1991年12月,456例患者因结直肠癌肝转移接受了肝切除。确定了96例实际的5年生存者(21%),并对他们的临床病程进行了回顾性分析。
与未存活5年的患者(n = 298)相比,5年生存者(n = 96)更可能患有杜克B期原发性结直肠癌、转移灶少于4个、单叶病变且组织学切缘阴性。96例5年生存者中有44例(46%)肝切除术后复发。在这44例中,19例(43%)经进一步治疗后疾病缓解。总体而言,96例5年生存者中有71例在最后一次随访时无疾病。该组的10年预期生存率为78%。
肝切除术后5年无疾病的患者可能已通过肝切除治愈。由于有进一步治疗和长期生存的可能性,应对患者进行积极随访以监测复发情况。