结直肠癌肝转移肝切除术后不同复发模式的预后差异及危险因素分析

摘要/Abstract

摘要： 目的：研究结直肠癌肝转移肝切除术后不同复发模式的预后差异及危险因素。
方法：收集2009年1月至2023年2月北京大学第三医院收治的因结直肠癌肝转移接受肝切除术患者的临床资料,使用Kaplan-Meier 生存曲线分析不同复发时间、不同复发部位之间的生存差异。使用最大选择检验法寻找用于区分复发后生存时间的最佳复发时间截断值,通过Logistic回归分析早期复发的危险因素。
结果：共281例患者符合纳入及排除标准。术后复发患者与无复发患者的死亡率和总生存时间差异均有统计学意义（P<0.001）。用于区分早期和晚期复发的最佳截断值为12个月（P<0.001）,早期复发与晚期复发患者的复发后生存时间差异有统计学意义（P=0.001 1）。不同复发部位的复发后生存时间差异有统计学意义（P=0.002 3）,首次复发部位为肺的患者预后最好。Logistic回归分析结果示原发灶淋巴结转移阳性（OR=2.294,95%CI为1.171~4.496,P=0.019）、术前癌胚抗原≥5.31 ng/ml（OR=2.160,95%CI为1.001~4.660, P=0.049 8）和术前糖类抗原19-9≥40.52 U/ml（OR=2.210,95%CI为1.030~4.741, P=0.042）是术后早期复发的高风险人群。
结论：结直肠癌肝转移肝切除术后12月内复发及肺外复发与不良预后相关。早期复发的危险因素包括原发灶淋巴结转移阳性、术前癌胚抗原≥5.31ng/ml和术前糖类抗原19-9≥40.52 U/ml,对具有相关危险因素的患者应积极进行复查和监测。

关键词: 结直肠癌, 肝转移, 肝切除术, 复发, 预后, 危险因素

Abstract: Objective: To study the prognostic differences and risk factors of different recurrence patterns after hepatectomy for colorectal liver metastasis.
Methods: The general data, clinical data and follow-up data of patients with colorectal liver metastasis who underwent hepatectomy in the Department of General Surgery of Peking University Third Hospital from January 2009 to February 2023 were collected. Kaplan-Meier curve was used to analyze the survival differences between different recurrence times and different recurrence sites. The maximally selected test was used to find the optimal cut-off value of recurrence time for distinguishing the survival after recurrence. Logistic regression analysis were used to analyze the risk factors of early recurrence.
Results: A total of 281 patients met the inclusion and exclusion criteria. There were statistically significant differences in mortality and overall survival between patients with and without postoperative recurrence (P=0.001). The optimal cut-off value for distinguishing early and late recurrence was 12 months (P=0.001). There was a statistically significant difference in the post-recurrence survival between patients with early recurrence and late recurrence (P=0.001 1). There was a statistically significant difference in the post-recurrence survival between different recurrence sites (P=0.002 3), and the prognosis of patients with the first recurrence site in the lung was the best. Logistic regression analysis showed that patients with positive lymph node metastasis of primary tumor (OR=2.294, 95%CI:1.171-4.496, P=0.019), preoperative CEA≥5.31 ng/ml (OR=2.160, 95%CI:1.001-4.660, P=0.049 8) and preoperative CA19-9≥ 40.52 U/ml (OR=2.210, 95%CI:1.030-4.741, P=0.042) were at high risk of early recurrence after surgery.
Conclusions: The recurrence within 12 months and extrapulmonary recurrence is associated with poor prognosis. The risk factors for early recurrence include positive lymph node metastasis of primary tumor, preoperative CEA≥5.31 ng/ml and preoperative CA19-9≥ 40.52 U/ml. Patients with related risk factors should be actively reviewed and monitored.

Key words: Colorectal cancer, Liver metastasis, Hepatectomy, Recurrence, Prognosis, Risk factors

陈瀚玮, 李磊. 结直肠癌肝转移肝切除术后不同复发模式的预后差异及危险因素分析[J]. 肝癌电子杂志, 2024, 11(2): 27-32.

Chen Hanwei, Li Lei. Prognosis and risk factors of different recurrence patterns after hepatectomy for colorectal liver metastasis[J]. Electronic Journal of Liver Tumor, 2024, 11(2): 27-32.

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