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

doi:10.3877/cma.j.issn.2095-3232.2020.04.007

Abstract

Abstract:

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

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.

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References 20

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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）
组别	例数	男	女	年龄（岁，±s ）	<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）
组别	例数	转移瘤最大径（cm，±s ）	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

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）
组别	例数	男	女	年龄（岁，±s ）	<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）
组别	例数	转移瘤最大径（cm，±s ）	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

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	?	?

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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