Bakalakos E A, Kim J A, Young D C, Martin E W
Division of Surgical Oncology, Arthur G. James Cancer Hospital and Research Institute (JCHRI), Ohio State University, Columbus 43210, USA.
World J Surg. 1998 Apr;22(4):399-404; discussion 404-5. doi: 10.1007/s002689900404.
Hepatic resection remains the only potentially curative treatment for metastatic colorectal cancer. This retrospective review study was undertaken in an attempt to identify factors that influence patient survival following hepatic resection for metastatic colorectal cancer. From January 1978 to December 1993, a total of 301 patients underwent a total of 345 planned hepatic resections for metastatic colorectal cancer. Of those, 245 patients had one resection, 44 had two resections, and 12 had three resections. For all patients the overall median survival was 20.6 months, operative mortality was 1.1%, and overall morbidity was 17.2%. Average hospital stay was 9 days. Statistical analysis included univariate analysis using log rank comparisons, Kaplan-Meier survival curves, and multivariate analysis using Cox proportional hazards regression. The statistically significant factors that influenced survival were distribution of liver metastases, unilobar versus bilobar (p = 0.0001), resected versus nonresected (p < 0.0001), and tumor-free surgical margins versus positive margins (p = 0.001). Surprisingly, the disease-free interval and the original stage of the primary tumor did not predict survival (p = not significant). Other factors that had no influence on survival were type of resection, size and number of liver metastases, ABO blood group, and the number of perioperative blood transfusions. For those patients who underwent resection of unilobar metastases with tumor-free margins, the 5-year survival rate was 29% with a median survival of 35 months and eight survivors > 7 years. In addition, one patient with bilobar disease had survival > 7 years and five patients who had resection of hepatic metastases and extrahepatic cancer simultaneously had survival > 3 years. Our data support the concept that patients with unilobar metastatic disease who undergo surgical resection with tumor-free surgical margins can be afforded a significant opportunity at long-term survival with acceptable morbidity, mortality, and hospital stay. Also, certain patients with bilobar or extrahepatic disease (or both) who undergo complete resection can enjoy a long-term survival. In these subgroups of patients resection should be considered on an individual basis.
肝切除术仍然是转移性结直肠癌唯一可能治愈的治疗方法。本回顾性研究旨在确定影响转移性结直肠癌肝切除术后患者生存的因素。1978年1月至1993年12月，共有301例患者因转移性结直肠癌接受了345次计划性肝切除术。其中，245例患者接受了一次切除，44例接受了两次切除，12例接受了三次切除。所有患者的总中位生存期为20.6个月，手术死亡率为1.1%，总发病率为17.2%。平均住院时间为9天。统计分析包括使用对数秩比较的单因素分析、Kaplan-Meier生存曲线以及使用Cox比例风险回归的多因素分析。影响生存的统计学显著因素包括肝转移的分布、单叶与双叶（p = 0.0001）、切除与未切除（p < 0.0001）以及无瘤手术切缘与阳性切缘（p = 0.001）。令人惊讶的是，无病间期和原发肿瘤的初始分期并不能预测生存（p = 无显著性）。其他对生存无影响的因素包括切除类型、肝转移的大小和数量、ABO血型以及围手术期输血次数。对于那些接受无瘤切缘的单叶转移瘤切除术的患者，5年生存率为29%，中位生存期为35个月，8名幸存者存活超过7年。此外,一名双叶疾病患者存活超过7年，5名同时接受肝转移瘤和肝外癌切除术的患者存活超过3年。我们的数据支持这样的观点，即接受无瘤手术切缘的手术切除的单叶转移性疾病患者有显著的长期生存机会，且发病率、死亡率和住院时间均可接受。此外，某些接受完全切除的双叶或肝外疾病（或两者兼有）患者也可长期存活。对于这些亚组患者，应根据个体情况考虑是否进行切除。
