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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2020, Vol. 09 ›› Issue (04) : 324 -328. doi: 10.3877/cma.j.issn.2095-3232.2020.04.007

所属专题： 文献；

临床研究

不同部位结肠癌肝转移临床病理特点及其术后预后影响因素分析
施长鹰1, 董志涛1, 廖博懿1, 乔亮1, 沈伟峰1, 杨甲梅1,†()   
  1. 1. 200438　上海东方肝胆外科医院特需一科
  • 收稿日期:2020-03-06 出版日期:2020-08-10
  • 通信作者: 杨甲梅

Clinicopathological characteristics of colon cancer in different sites with liver metastases and analysis of postoperative prognostic factors

Changying Shi1, Zhitao Dong1, Boyi Liao1, Liang Qiao1, Weifeng Shen1, Jiamei Yang1,†()   

  1. 1. Department of Special Treatment, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai 200438, China
  • Received:2020-03-06 Published:2020-08-10
  • Corresponding author: Jiamei Yang
  • About author:
    Corresponding author: Yang Jiamei, Email:
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施长鹰, 董志涛, 廖博懿, 乔亮, 沈伟峰, 杨甲梅. 不同部位结肠癌肝转移临床病理特点及其术后预后影响因素分析[J]. 中华肝脏外科手术学电子杂志, 2020, 09(04): 324-328.

Changying Shi, Zhitao Dong, Boyi Liao, Liang Qiao, Weifeng Shen, Jiamei Yang. Clinicopathological characteristics of colon cancer in different sites with liver metastases and analysis of postoperative prognostic factors[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2020, 09(04): 324-328.

目的

探讨不同部位结肠癌肝转移（CLM）临床病理特征及其术后影响因素。

方法

回顾性分析2009年1月至2015年6月在上海东方肝胆外科医院行肝部分切除的106例CLM患者临床资料。其中男64例，女42例；年龄33～70岁，中位年龄57岁。患者均签署知情同意书，符合医学伦理学规定。根据原发灶部位不同将患者分为左半结肠癌组（56例）和右半结肠癌组（50例），观察两组临床病理学差异和生存预后，分析CLM预后因素。率的比较采用χ2检验。单因素和生存分析采用Kaplan-Meier法和Log-rank检验。采用Cox回归分析影响预后的独立危险因素。

结果

左、右半结肠癌组发生淋巴结转移患者分别为20、29例，右半结肠癌组淋巴分期更晚（χ2=5.278，P<0.05）。左、右半结肠癌组中位总生存时间分别为55、44个月，右半结肠癌组预后更差（χ2=4.376，P<0.05）。单因素分析结果显示，年龄、CEA、原发灶位置、淋巴结转移、肝转移时间间隔、转移瘤数目、再复发后治疗反应为CLM患者术后总体生存的影响因素（χ2=3.941，6.194，4.376，4.355，7.106，6.550，7.250；P<0.05）。多因素分析显示，术前CEA水平≥200 μg/L、再复发后治疗非完全缓解是影响CLM患者术后总体生存的独立危险因素（HR=1.748，2.265；P<0.05）。

结论

原发灶位于右半结肠的CLM患者预后更差，CEA水平和再复发治疗反应是影响其远期预后的独立因素。

关键词: 结直肠肿瘤, 肿瘤转移, 肝切除术, 预后
Objective

To explore the clinicopathological characteristics of different sites colon cancer with liver metastasis (CLM) and their postoperative prognostic factors.

Methods

Clinical data of 106 patients with CLM who underwent partial liver resection from January 2009 to June 2015 at Shanghai Eastern Hepatobiliary Surgery Hospital were retrospectively analyzed. Among them, 64 were male and 42 female, aged 33-70 years and with a median of 57 years. The informed consents of all patients were obtained and the local ethical committee approval was received. Patients were assigned to left colon cancer group (n=56) and right colon cancer group (n=50) according to the different location of primary foci, and the clinicopathological difference and survival prognosis between two groups was observed. The prognostic factors of CLM were analyzed. Comparisons in rate were performed by Chi-square test. Univariate and survival analyses were performed using Kaplan-Meier method and Log-rank test. Independent risk factors for the prognosis were analyzed using Cox regression.

Results

There were 20 and 29 cases with lymph node metastasis in the left and right colon cancer groups, respectively, and the lymph node staging in right colon cancer group was more advanced (χ2=5.278, P<0.05). The median overall survival in the left and right colon cancer group was 55 and 44 months, respectively, and the right colon cancer group had poorer prognosis (χ2=4.376, P<0.05). Univariate analysis indicated that age, CEA, location of primary foci, lymphatic metastasis, time interval across liver metastases, number of metastases, and response to treatment after recurrence were the influencing factors for the postoperative overall survival of CLM patients (χ2=3.941, 6.194, 4.376, 4.355, 7.106, 6.550, 7.250; P<0.05). Multivariate analysis showed that preoperative CEA level ≥200 μg/L and incomplete remission to treatment after recurrence were the independent risk factors for postoperative overall survival in CLM patients (HR=1.748, 2.265; P<0.05).

Conclusions

CLM with the primary foci located in the right-sided colon has poorer prognosis. CEA levels and response to treatment after recurrence are the independent factors for long-term prognosis.

Key words: Colorectal neoplasms, Neoplasm metastasis, Hepatectomy, Prognosis
表1 左半结肠癌组和右半结肠癌组患者临床病理特征比较
组别 例数 性别（例） 年龄（岁，±s ） CEA（例） 原发瘤T分期（例） 原发瘤N分期（例） 肝转移间隔（例）
男 女 <200 μg/L ≥200 μg/L ≤12个月 ≤12个月 N0 N1、N2 ≤12个月 >12个月
左半结肠癌组 56 33 23 55±9 38 18 42 14 36 20 22 34
右半结肠癌组 50 31 19 56±9 31 19 33 17 21 29 28 22
统计值 ? χ2=0.104 t=-0.048 χ2=0.399 χ2=1.034 χ2=5.278 χ2=2.961
P值 ? 0.747 0.828 0.528 0.309 0.022 0.085
组别 例数 转移瘤最大径（cm，±s ） 转移瘤数量（例） 手术切缘（例） 分化程度（例） 新辅助化疗（例） 再复发后治疗反应（例）
单发 多发 R0 R1 低分化 中-高分化 无 有 完全缓解 非完全缓解
左半结肠癌组 56 4.4±1.3 28 28 35 21 33 18 45 11 11 38
右半结肠癌组 50 4.5±1.4 30 20 35 15 33 17 45 5 10 38
统计值 ? t=-0.765 χ2=1.066 χ2=0.663 χ2=0.041 χ2=1.917 χ2=0.037
P值 ? 0.384 0.302 0.416 0.839 0.166 0.847
图1 结肠癌肝转移患者术后总体生存Kaplan-Meier曲线
表2 106例结肠癌肝转移患者术后总体生存的单因素影响分析
因素 例数 中位生存时间（月） 95% CI χ2值 P值
性别 ? ? ? 1.575 0.209
? 男 64 48 41～55 ? ?
? 女 42 48 35～61 ? ?
年龄（岁） ? ? ? 3.941 0.047
? <65 87 51 42～60 ? ?
? ≥65 19 40 39～41 ? ?
CEA （μg/L） ? ? ? 6.194 0.013
? <200 69 56 48～65 ? ?
? ≥200 37 43 36～50 ? ?
原发灶位置 ? ? ? 4.376 0.036
? 左半结肠 56 55 47～63 ? ?
? 右半结肠 50 44 38～50 ? ?
T分期 ? ? ? 2.586 0.108
? T1/2 75 53 46～60 ? ?
? T3/4 31 42 39～45 ? ?
N分期 ? ? ? 4.355 0.037
? N0 57 56 48～64 ? ?
? N1/2 49 44 37～51 ? ?
肝转移时间间隔（月） ? ? ? 7.106 0.008
? >12 56 57 50～64 ? ?
? ≤12 50 41 36～46 ? ?
转移瘤数量 ? ? ? 6.550 0.010
? 单发 58 57 47～67 ? ?
? 多发 48 45 39～51 ? ?
转移瘤最大径（cm） ? ? ? 0.638 0.424
? <5 79 46 36～56 ? ?
? ≥5 27 51 45～57 ? ?
手术切缘 ? ? ? 0.172 0.679
? R0 70 48 39～57 ? ?
? R1 36 51 38～64 ? ?
分化程度 ? ? ? 1.404 0.236
? 低分化 71 48 43～53 ? ?
? 中-高分化 35 51 34～68 ? ?
新辅助化疗 ? ? ? 0.031 0.861
? 是 16 47 44～50 ? ?
? 否 90 51 41～62 ? ?
再复发后治疗反应 ? ? ? 7.250 0.007
? 完全缓解 21 60 47～73 ? ?
? 非完全缓解 76 44 40～48 ? ?
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