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中华结直肠疾病电子杂志 ›› 2021, Vol. 10 ›› Issue (02) : 194 -200. doi: 10.3877/cma.j.issn.2095-3224.2021.02.013

所属专题: 文献

论著

外科治疗策略对结直肠癌同时性肝转移患者预后改善的影响
马晓龙1, 关旭1, 杨润坤2, 赵志勋1, 刘恩瑞1, 黄海洋1, 陈海鹏1, 刘正1, 姜争1, 陈瑛罡3,(), 王锡山1,()   
  1. 1. 100021 北京,国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院结直肠外科
    2. 150081 哈尔滨医科大学附属第二医院结直肠肿瘤外科
    3. 518116 国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院深圳医院胃肠外科
  • 收稿日期:2020-12-08 出版日期:2021-04-25
  • 通信作者: 陈瑛罡, 王锡山
  • 基金资助:
    深圳市‘医疗卫生三名工程’(SZSM201911012); 中国医学科学院医学与健康科技创新工程项目(2016-I2M-1-001); 北京市科技计划(D171100002617004)

Improved survival in synchronous liver metastases with colorectal cancer is associated with surgical strategy

Xiaolong Ma1, Xu Guan1, Runkun Yang2, Zhixun Zhao1, Enrui Liu1, Haiyang Huang1, Haipeng Chen1, Zheng Liu1, Zheng Jiang1, Yinggang Chen3,(), Xishan Wang1,()   

  1. 1. Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical ciences and Peking Union Medical College, Beijing 100021, China
    2. Department of Colorectal Surgery, the Second Affiliated Hospital of Harbin Medical University
    3. Department of Gastrointestinal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
  • Received:2020-12-08 Published:2021-04-25
  • Corresponding author: Yinggang Chen, Xishan Wang
引用本文:

马晓龙, 关旭, 杨润坤, 赵志勋, 刘恩瑞, 黄海洋, 陈海鹏, 刘正, 姜争, 陈瑛罡, 王锡山. 外科治疗策略对结直肠癌同时性肝转移患者预后改善的影响[J/OL]. 中华结直肠疾病电子杂志, 2021, 10(02): 194-200.

Xiaolong Ma, Xu Guan, Runkun Yang, Zhixun Zhao, Enrui Liu, Haiyang Huang, Haipeng Chen, Zheng Liu, Zheng Jiang, Yinggang Chen, Xishan Wang. Improved survival in synchronous liver metastases with colorectal cancer is associated with surgical strategy[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2021, 10(02): 194-200.

目的

化疗及外科治疗策略的优化使结直肠癌肝转移患者生存期得到了明显改善。本研究拟利用中国国家癌症中心数据库数据评价同时性结直肠癌肝转移患者的生存率变化以及探讨其与治疗策略之间的关系。

方法

回顾性分析2010年1月~2018年2月在国家癌症中心/中国医学科学院肿瘤医院诊治的结直肠癌同时性肝转移患者临床资料,按确诊年度,分为2010~2011年、2012~2013年、2014~2015年、2016~2017年四组,比较其肿瘤特异性生存时间及外科治疗策的差异。

结果

本研究共纳入1 286例患者,中位生存时间从2010~2011年度的20个月提高到2016~2017年度的33个月。3年肿瘤特异性生存率从23.0%提高到45.3%。5年肿瘤特异性生存率从9.5%提高到35.2%。接受原发灶切除和肝转移灶局部治疗患者生存优于单纯化疗组、单纯原发灶切除组和肝转移灶局部治疗组。

结论

基于人群的研究显示同时性结直肠癌肝转移患者整体生存得到显著改善。在接受化疗的同时,患者接受外科治疗策略比例的增高与生存率升高有关。

Objective

The optimization of chemotherapy and surgical strategies has significantly improved the survival of patients with colorectal cancer liver metastases. This study intends to use the data from the National Cancer Center of China to describe the survival rate of synchronous liver metastases with colorectal cancer patients and explore the relationship with treatment strategies.

Methods

A retrospective analysis of the clinical data of patients with synchronous liver metastases of colorectal cancer diagnosed and treated at the National Cancer Center/ Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from January 2010 to February 2018. According to the year of diagnosis, the patent divided into four groups including 2010 to 2011, 2012 to 2013, 2014 to 2015 and 2016 to 2017. The cancer-specific survival and surgical strategy differences were analyzed.

Results

A total of 1 286 patients with colorectal cancer were included in this study, and the median survival time increased from 20 months in 2010-2011 to 33 months in 2016-2017. The 3-year cancer-specific survival rate increased from 23.0% to 45.3%. The 5-year cancer-specific survival rate increased from 9.5% to 35.2%. The survival of patients receiving primary tumor resection and liver metastasis local treatment was better than that of chemotherapy alone group, primary tumor resection group and liver metastasis local treatment group.

Conclusion

This population-based study has shown the cancer-specific survival of patients has been significantly improved in synchronous liver metastases of colorectal cancer patient. The proportion of receiving surgical strategies increased is related to better survival.

表1 患者临床病理资料[例(%)]
图1 不同诊治年度,结直肠癌同时性肝转移患者的总体生存。1A:Kaplan-Meier曲线;1B:中位生存时间,误差棒代表95%可信区间。1C:3年肿瘤特异性生存率,误差棒代表标准误;1D:5年肿瘤特异性生存率,误差棒代表标准误。*表示2016~2017年度,5年CSS的统计预测
图2 不同诊治年度不同治疗策略所占比例
图3 不同治疗策略,结直肠癌同时性肝转移患者的总体生存。3A:Kaplan-Meier曲线;3B:中位生存时间,误差棒代表95%可信区间;3C:3年肿瘤特异性生存率。误差棒代表标准误
图4 接受不同治疗策略的M1各分期的结直肠癌同时性肝转移患者的总体生存。4A:M1a期Kaplan-Meier曲线;4B:M1b期Kaplan-Meier曲线;4C:M1c期Kaplan-Meier曲线
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