【摘要】：目的:比較分析新輔助化療聯(lián)合手術(shù)對(duì)比單獨(dú)手術(shù)對(duì)可切除結(jié)腸癌肝轉(zhuǎn)移患者生存的影響,評(píng)價(jià)新輔助化療在可切除結(jié)腸癌肝轉(zhuǎn)移患者中的價(jià)值。方法:回顧性分析2010年1月到2015年12月在中國(guó)醫(yī)學(xué)科學(xué)院腫瘤醫(yī)院行手術(shù)治療的符合入組條件的85例結(jié)腸癌肝轉(zhuǎn)移患者,按照術(shù)前是否行新輔助化療分為兩組:新輔助化療聯(lián)合手術(shù)組(n=37)和單純手術(shù)組(n=48),對(duì)比分析兩組的臨床特征,兩組患者的臨床病理特征無(wú)顯著性差異,具有可比性。并用Kaplan-Meier法繪制生存曲線,用Log-rank檢驗(yàn)比較兩組患者生存率的差異,COX回歸分析影響生存的因素,以P0.05界定為有顯著性差異。結(jié)果:新輔助化療聯(lián)合手術(shù)組的患者中位總生存時(shí)間(overall survival,OS)為36個(gè)月,中位疾病無(wú)進(jìn)展生存時(shí)間(disease-free survival,DFS)為19個(gè)月,3年和1年生存率分別為33%和80%。單純手術(shù)組的患者中位OS為31個(gè)月,中位DFS為16個(gè)月,3年和1年的生存率分別為25%和67%。新輔助化療聯(lián)合手術(shù)組疾病進(jìn)展的發(fā)生率為62.2%,單純手術(shù)組的疾病進(jìn)展的發(fā)生率為72.9%,兩組患者術(shù)后不良反應(yīng)、OS和DPS上無(wú)顯著性差異(p=0.388和p=0.225),但是在對(duì)亞組的分析中發(fā)現(xiàn),原發(fā)腫瘤位于右半結(jié)腸、≥4個(gè)肝轉(zhuǎn)移灶、最大肝轉(zhuǎn)移灶直徑5cm、血清CEA(carcino-embryonic antigen,癌胚抗原)≥5ng/ml、腫瘤切緣陽(yáng)性是影響預(yù)后的因素,COX多因素分析進(jìn)一步驗(yàn)證血清CEA≥5ng/ml、肝轉(zhuǎn)移灶5cm、腫瘤切緣陽(yáng)性為本研究中影響患者預(yù)后的獨(dú)立危險(xiǎn)因素。結(jié)論:同單純手術(shù)相比,新輔助化療并沒(méi)有增加死亡率及術(shù)后相關(guān)并發(fā)癥,但同時(shí)也沒(méi)有OS和DFS上的優(yōu)勢(shì),亞組的分析中發(fā)現(xiàn),血清CEA≥5ng/ml、肝轉(zhuǎn)移灶5cm、腫瘤切緣陽(yáng)性是結(jié)腸癌肝轉(zhuǎn)移的獨(dú)立危險(xiǎn)因素。
[Abstract]:Aim: to compare the effects of neoadjuvant chemotherapy combined with surgery on survival of patients with liver metastasis of resectable colon cancer and evaluate the value of neoadjuvant chemotherapy in patients with liver metastasis of resectable colon cancer. Methods: from January 2010 to December 2015, 85 patients with liver metastasis of colon cancer who were treated by operation in Cancer Hospital of Chinese Academy of Medical Sciences were retrospectively analyzed. According to whether or not neoadjuvant chemotherapy was performed before operation, two groups were divided into two groups: neoadjuvant chemotherapy combined with operation group (n = 37) and simple operation group (n = 48). The clinical features of the two groups were compared and analyzed. There was no significant difference in clinical and pathological features between the two groups, and the clinical and pathological features of the two groups were comparable. Kaplan-Meier method was used to draw survival curve, Log-rank test was used to compare the difference of survival rate between the two groups. COX regression analysis showed that there was significant difference between the two groups (P0.05). Results: the median total survival time (overall survival,OS) was 36 months, the median progression-free survival time (disease-free survival,DFS) was 19 months, and the 3-year and 1-year survival rates were 33% and 80%, respectively. The median OS was 31 months and the median DFS was 16 months in the simple operation group. The 3-year and 1-year survival rates were 25% and 67%, respectively. The incidence of disease progression was 62.2% in neoadjuvant chemotherapy combined with surgery group and 72.9% in simple operation group. There was no significant difference in OS and DPS between the two groups in postoperative adverse reactions (p < 0. 388 and p < 0. 225), but there was no significant difference between the two groups (p < 0. 388 and p = 0. 225). But in the subgroup analysis, it was found that the primary tumor was located in the right hemicolon, 鈮，

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