Surviv alanalysis of synchronous colorectal liver metastases

doi:10.3877/cma.j.issn.2095-3224.2014.02.08

Abstract

Abstract:

Objective

To conducte survival analysis of synchronous colorectal liver metastases(SCRLM).

Methods

Retrospectively collected clinicopathologic data of 1061 SCRLM patients, and then conducted univariate and Cox regression analyses.

Results

For patients with resectable SCRLM, synchronous resection could reduce the expense compared with asynchronous resection, while there were no significant differences in short-term complications or long-term survival.For asymptomatic unresectable SCRLM patients, resection of primary tumor could improve long-term survival.Poor differentiation of primary tumor, number of liver metastases≥4, maximum liver metastasis≥5 cm, extra-liver metastases, no resection of primary tumor and no surgical treatment of liver metastases were independent prognosis factors.Giving one point to each above factor, all SCRLM patients were divided into low-risk(0~1), medium-risk(2~3)and high-risk(4~6)groups which 5-year-survival rates are 51%, 16% and 0% respectively.

Conclusions

In patients with resectable SCRLM, synchronous resection of primary tumor and liver metastases was the optimal choice.In asymptomatic patients with unresectable SCRLM, resection of primary tumor was recommended at the right time.The prediction model should be used to guide clinical management of SCRLM patients.

Key words: Colorectal neoplasms, Neoplasm metastasis, Colorectal surgery, Prognosis

De-xiang ZHU, Qi LIN, Yun-shi ZHONG, Ye WEI, Li REN, Jian-min XU, Xin-yu QIN. Surviv alanalysis of synchronous colorectal liver metastases[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2014, 03(02): 104-110.

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URL: https://zhjzcjbdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3224.2014.02.08

https://zhjzcjbdzzz.cma-cmc.com.cn/EN/Y2014/V03/I02/104

Figures/Tables 5

References 25

[1]	Adam R．Colorectal cancer with synchronous liver metastases.Br J Surg，2007,94(2):129-131.
[2]	Sharma S，Camci C，Jabbour N．Management of hepatic metastasis from colorectal cancers：an update.J Hepatobiliary Pancreat Surg，2008,15(6):570-580.
[3]	Xu J，Qin X，Wang J，et al.Chinese guidelines for the diagnosis and comprehensive treatment of hepatic metastasis of colorectal cancer.J Cancer Res Clin Oncol，2011,137(9):1379-1396.
[4]	Pawlik TM，Choti MA.Surgical therapy for colorectal metastases to the liver.J Gastrointest Surg，2007,11(8):1057-1077.
[5]	Robinson S，Manas DM，Pedley I，et al.Systemic chemotherapy and its implications for resection of colorectal liver metastasis.Surg Oncol，2011,20(2):57-72.
[6]	Kopetz S，Chang GJ，Overman MJ，et al.Improved survival in metastatic colorectal cancer is associated with adoption of hepatic resection and improved chemotherapy.J Clin Oncol，2009,27(22):3677-3683.
[7]	International registry of liver metastases of colorectal cancer.2014-03-05. URL
[8]	Chen GQ，Li J，Ding KF.A meta-analysis of the safety of simultaneous versus staged resection for synchronous liver metastasis from colorectal cancer.Zhonghua Wei Chang Wai Ke Za Zhi，2010,13(5):337-341.
[9]	de Haas RJ，Adam R，Wicherts DA，et al.Comparison of simultaneous or delayed liver surgery for limited synchronous colorectal metastases.Br J Surg，2010,97(8):1279-1289.
[10]	Chen J，Li Q，Wang C，et al.Simultaneous vs.staged resection for synchronous colorectal liver metastases：a metaanalysis.Int J Colorectal Dis，2011,26(2):191-199.
[11]	Moug SJ，Horgan PG.The role of synchronous procedures in the treatment of colorectal liver metastases.Surg Oncol，2007,16(1):53-58.
[12]	Poultsides GA，Servais EL，Saltz LB，et al.Outcome of primary tumor in patients with synchronous stage IV colorectal cancer receiving combination chemotherapy without surgery as initial treatment.J Clin Oncol，2009,27(20):3379-3384.
[13]	Damjanov N，Weiss J，Haller DG.Resection of the primary colorectal cancer is not necessary in nonobstructed patients with metastatic disease.Oncologist，2009,14(10):963-969.
[14]	Aslam MI，Kelkar A，Sharpe D，et al.Ten years experience of managing the primary tumours in patients with stage IV colorectal cancers.Int J Surg，2010,8(4):305-313.
[15]	Karoui M，Roudot-Thoraval F，Mesli F，et al.Primary colectomy in patients with stage IV colon cancer and unresectable distant metastases improves overall survival：results of a multicentric study.Dis Colon Rectum，2011,54(8):930-938.
[16]	Bs L，AZ，Te S，et al.Role of surgical resection among chemotherapy-treated patients with colorectal cancer stage IV disease：a survival analysis.Chicago：McCormick Place，2011.
[17]	Stillwell A P，Buettner PG，Ho YH.Meta-analysis of survival of patients with stage IV colorectal cancer managed with surgical resection versus chemotherapy alone.World J Surg，2010,34(4):797-807.
[18]	Verhoef C，de Wilt JH，Burger JW，et al.Surgery of the primary in stage IV colorectal cancer with unresectable metastases.Eur J Cancer，2011,47(3):61-66.
[19]	Anwar S，Peter MB，Dent J，et al.Palliative excisional surgery for primary colorectal cancer in patients with incurable metastatic disease.Is there a survival benefit? A systematic review.Colorectal Dis，2012,14(8):920-930.
[20]	Stillwell AP，Ho YH，Veitch C．Systematic review of prognostic factors related to overall survival in patients with stage IV colorectal cancer and unresectable metastases.World J Surg，2011,35(3):684-692.
[21]	Gallagher DJ，Kemeny N．Metastatic colorectal cancer：from improved survival to potential cure.Oncology，2010,78(3-4):237-248.
[22]	Mocellin S，Pasquali S，Nitti D．Fluoropyrimidine-HAI(hepatic arterial infusion)versus systemic chemotherapy(SCT)for unresectable liver metastases from colorectal cancer.Cochrane Database Syst Rev，2009(3):D7823.
[23]	Kulaylat MN，Gibbs JF.Regional treatment of colorectal liver metastasis.J Surg Oncol，2010,101(8):693-698.
[24]	Rees M，Tekkis PP，Welsh FK，et al.Evaluation of long-term survival after hepatic resection for metastatic colorectal cancer：a multifactorial model of 929 patients.Ann Surg，2008,247(1):125-135.
[25]	Welsh FK，Tekkis PP，John TG，et al.Predictive models in colorectal liver metastases-can we personalize treatment and outcome? Dig Surg，2008,25(6):406-412.

?		同步切除(151例)	分期切除(83例)	P
性别(男：女)		98：53	56：27	>0.050
中位年龄(岁)		59(32-80)	57(28-80)	>0.050
肠道原发部位		?	?	>0.050
?	直肠	41	27	?
?	乙状结肠	27	24	?
?	降结肠和脾曲	15	2	?
?	横结肠	9	2	?
?	盲升结肠和肝曲	59	28	?
中位治疗前CEA水平(ng/ml)		12.06	9.89	>0.050
中位治疗前CA19－9水平(U/ml)		18.18	35.80	>0.050
累及肝叶数		?	?	>0.050
?	单叶	117	63	?
?	双叶	34	20	?
肝转移灶个数		?	?	>0.050
?	1-3个病灶	135	72	?
?	≥4个病灶	16	11	?
中位最大肝转移灶直径(cm)		3.01	3.23	>0.050

?		同步切除(151例)	分期切除(83例)	P
性别(男：女)		98：53	56：27	>0.050
中位年龄(岁)		59(32-80)	57(28-80)	>0.050
肠道原发部位		?	?	>0.050
?	直肠	41	27	?
?	乙状结肠	27	24	?
?	降结肠和脾曲	15	2	?
?	横结肠	9	2	?
?	盲升结肠和肝曲	59	28	?
中位治疗前CEA水平(ng/ml)		12.06	9.89	>0.050
中位治疗前CA19－9水平(U/ml)		18.18	35.80	>0.050
累及肝叶数		?	?	>0.050
?	单叶	117	63	?
?	双叶	34	20	?
肝转移灶个数		?	?	>0.050
?	1-3个病灶	135	72	?
?	≥4个病灶	16	11	?
中位最大肝转移灶直径(cm)		3.01	3.23	>0.050

变量		例数	中位生存期(月)	5年存活率(%)	单因素分析	多因素分析
性别		?	?	?	0.050	/
?	女性	370	19.8	19	?	?
?	男性	691	21.8	20	?	?
年龄		?	?	?	0.162	/
?	<70岁	821	21.3	22%	?	?
?	≥70岁	240	20.2	12%	?	?
肠癌分化程度		?	?	?	<0.001	<0.001
?	分化I～II级	547	25.6	23%	?	?
?	分化III～IV级	514	16.1	16%	?	?
肠癌浸润深度		?	?	?	0.754	/
?	T1～3	382	22.7	22%	?	?
?	T4	679	20.4	19%	?	?
肠癌淋巴结转移情况		?	?	?	<0.001	0.778
?	N0	225	32.0	31%	?	?
?	N1～2	836	19.8	16%	?	?
肝转移灶累及叶数		?	?	?	<0.001	0.715
?	单叶	437	22.8	22%	?	?
?	双叶	624	19.5	17%	?	?
肝转移灶数目		?	?	?	<0.001	<0.001
?	<4个	369	35.7	36%	?	?
?	≥4个	692	17.7	10%	?	?
最大肝转移灶直径		?	?	?	<0.001	<0.001
?	<5 cm	507	30.4	29%	?	?
?	≥5 cm	554	16.1	9%	?	?
诊断肝转移时血清CEA水平		?	?	?	0.006	0.267
?	<5 ng/ml	203	24.8	24%	?	?
?	≥5 ng/ml	858	20.3	18%	?	?
肝外转移		?	?	?	0.007	0.005
?	无	936	21.7	20%	?	?
?	有	125	17.5	14%	?	?
原发灶是否手术切除		?	?	?	<0.001	<0.001
?	是	909	23.2	22%	?	?
?	否	152	9.3	0%	?	?
肝转移灶治疗措施		?	?	?	<0.001	<0.001
?	手术	301	47.3	46%	?	?
?	非手术	760	17.3	8%	?	?

变量		例数	中位生存期(月)	5年存活率(%)	单因素分析	多因素分析
性别		?	?	?	0.050	/
?	女性	370	19.8	19	?	?
?	男性	691	21.8	20	?	?
年龄		?	?	?	0.162	/
?	<70岁	821	21.3	22%	?	?
?	≥70岁	240	20.2	12%	?	?
肠癌分化程度		?	?	?	<0.001	<0.001
?	分化I～II级	547	25.6	23%	?	?
?	分化III～IV级	514	16.1	16%	?	?
肠癌浸润深度		?	?	?	0.754	/
?	T1～3	382	22.7	22%	?	?
?	T4	679	20.4	19%	?	?
肠癌淋巴结转移情况		?	?	?	<0.001	0.778
?	N0	225	32.0	31%	?	?
?	N1～2	836	19.8	16%	?	?
肝转移灶累及叶数		?	?	?	<0.001	0.715
?	单叶	437	22.8	22%	?	?
?	双叶	624	19.5	17%	?	?
肝转移灶数目		?	?	?	<0.001	<0.001
?	<4个	369	35.7	36%	?	?
?	≥4个	692	17.7	10%	?	?
最大肝转移灶直径		?	?	?	<0.001	<0.001
?	<5 cm	507	30.4	29%	?	?
?	≥5 cm	554	16.1	9%	?	?
诊断肝转移时血清CEA水平		?	?	?	0.006	0.267
?	<5 ng/ml	203	24.8	24%	?	?
?	≥5 ng/ml	858	20.3	18%	?	?
肝外转移		?	?	?	0.007	0.005
?	无	936	21.7	20%	?	?
?	有	125	17.5	14%	?	?
原发灶是否手术切除		?	?	?	<0.001	<0.001
?	是	909	23.2	22%	?	?
?	否	152	9.3	0%	?	?
肝转移灶治疗措施		?	?	?	<0.001	<0.001
?	手术	301	47.3	46%	?	?
?	非手术	760	17.3	8%	?	?

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