结直肠癌同时性肝转移不同治疗方法的预后分析

发布时间：2018-06-05 23:28

本文选题：结直肠癌 + 肝转移　；参考：《新疆医科大学》2017年硕士论文

【摘要】：目的:分析评价不同治疗方案对结直肠癌同时性肝转移的预后影响,总结直肠癌同时性肝转移的最佳治疗方案。方法:查阅相关文献和资料,采用回顾性分析的方法,选择新疆医科大学第一附属医院2010年1月至2014年12月收治的临床诊断(出院诊断)为结直肠癌同时性肝转移的临床病例121例。其中针对于转移灶分为单纯手术组22例,单纯化疗组43例,以手术为基础的联合治疗组56例,随访患者的生存期,分析患者的生存曲线来评价3组患者的预后情况,并通过long~rank检验和Cox回归模型对影响预后的相关因素进行单因素和多因素分析。结果:(1)不同治疗方案生存分析结果:所有入组的121例患者中位生存期为13(3~66)个月,单纯手术组10(3~39)个月,单纯化疗组7(3~36)个月,联合治疗组18(4~66)个月。(2)单纯手术组与单纯化疗组的中位生存期比较,P0.05,差异无统计学意义;联合治疗组与单纯手术组的中位生存期比较,P0.05,差异有统计学意义;联合治疗组与单纯化疗组的中位生存期比较,P0.01,差异有显著统计学意义;(3)对入组的121例患者对基础资料中的15个要素做单因素生存分析,结果显示:原发灶浸润深度、原发灶分化程度、淋巴结转移程度、脉管浸润程度、治疗方式、肝转移程度、肝转移灶数目、肝转移灶直径、肝转移灶切缘范围等9个要素差异均有统计学意义(P0.05)。(4)对具有影响的这9个要素纳入Cox风险比例回归模型进行分析,结果显示:其中淋巴结转移程度、肝转移程度、肝转移灶数目、肝转移灶直径、肝转移灶切缘范围、治疗方式等6个要素是结直肠癌肝转移的独立预后因素,P0.01,差异具有统计学意义;从相对危险度分析,除术后治疗方式和肝转移灶切除范围是患者预后的有利要素外其余4个要素均为不利要素,P0.05,差异无统计学意义。结论:(1)临床工作中,对于结直肠癌同时性肝转移的诊断和治疗要具体根据患者临床表现,此外还有相关的实验室检查和影像学检查以及基因检测结果来准确和及时的判定,并个性化制定治疗方案。目前,根据调查结果显示:保守治疗(放疗、化疗、射频)仍然是患者的主流选择治疗方案,但是在临床工作中,需要及时的把握手术指证,对于手术指证明确的患者,要及时手术治疗,以免延误病情,进而提高患者生存质量,延长患者生存时间,使患者获得更大的收益。(2)以手术为基础的联合治疗可以延长结直肠癌同时性肝转移患者的生存期,使患者获得更大的收益。
[Abstract]:Aim: to evaluate the prognostic effects of different treatment schemes on simultaneous liver metastasis of colorectal cancer and to summarize the best treatment for simultaneous liver metastasis of colorectal cancer. Methods: the relevant literature and materials were reviewed, and the methods of retrospective analysis were used. From January 2010 to December 2014, 121 patients with simultaneous liver metastasis from colorectal cancer were selected. The metastatic foci were divided into simple operation group (22 cases), chemotherapy group (43 cases) and combined therapy group (56 cases). The survival time of the patients was followed up. The survival curve of the patients was analyzed to evaluate the prognosis of the three groups. Univariate and multivariate analysis of prognostic factors were performed by long~rank test and Cox regression model. Results (1) Survival analysis of different treatments: the median survival time of 121 patients in all the groups was 13 ~ 366) months, that of simple operation group was 10 ~ 33 ~ 39) months, and that of chemotherapy group was 7 / 33 / 36 months. There was no significant difference in the median survival time between the simple operation group and the simple chemotherapy group (P 0.05), the median survival time of the combined treatment group and the simple operation group was significantly higher than that of the simple operation group (P 0.05), and the mean survival time of the combined treatment group was significantly higher than that of the simple operation group (P 0.05), while that of the combined treatment group was significantly higher than that of the simple operation group (P 0.05). The median survival time of the combined treatment group and the simple chemotherapy group was significantly higher than that of the chemotherapy group (P 0.01). A single factor survival analysis was performed on the 15 elements of the basic data in 121 patients who entered the group. The results showed that the invasion depth of the primary focus was greater than that of the control group. Primary tumor differentiation, lymph node metastasis, vascular infiltration, treatment, liver metastasis, number of liver metastases, diameter of liver metastases, There were significant differences among the 9 factors, such as the range of resection margin of liver metastases and so on. (P0.05. 4). The results showed that the degree of lymph node metastasis, the degree of liver metastasis, the degree of lymph node metastasis, and the degree of liver metastasis were analyzed by the regression model of the proportion of Cox risk. The number of hepatic metastases, the diameter of hepatic metastases, the margin of hepatic metastasis and the treatment methods were the independent prognostic factors of liver metastasis of colorectal cancer (P 0.01), the difference was statistically significant. The other four factors were all unfavorable factors (P0.05) except the treatment mode and the resection range of liver metastases. The difference was not statistically significant. Conclusion in clinical work, the diagnosis and treatment of simultaneous liver metastasis of colorectal cancer should be based on the clinical manifestations of the patient, in addition to the relevant laboratory and imaging examination and gene detection results to accurately and timely determine. And individualized treatment plan. At present, according to the survey results: conservative treatment (radiotherapy, chemotherapy, radio frequency) is still the mainstream treatment of patients, but in clinical work, we need to grasp the surgical evidence in time, for patients with clear surgical evidence, Surgical treatment should be done in time to avoid delay in the patient's condition, thereby improving the patient's quality of life and prolonging the patient's survival time. The combination therapy based on surgery can prolong the survival time of patients with simultaneous liver metastasis of colorectal cancer and increase the benefit of patients with liver metastasis.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.34

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