- 期刊
The Outcome of Different Initial Treatments for Colorectal Cancer with Synchronous Liver Metastasis: One Institution's Experience
分析以不同的起始方式治療大腸直腸癌併肝轉移的預後
摘要
Purpose. This retrospective study evaluated the outcome of patients with colorectal cancer and synchronous liver metastasis after they received different initial methods of treatment. Methods. Between 2008 and 2012, 273 patients were diagnosed with colorectal cancer with synchronous liver metastasis at Chi-Mei Medical Center. After excluding patients with peritoneal carcinomatosis or extra-hepatic metastasis, 150 patients were enrolled in the study. Of the 150 patients, 40 were treated with colectomy, 15 with synchronous colectomy and hepatectomy, 63 received chemotherapy as their initial treatment; and 32 received palliative care only. We then compared the clinicopathologic characteristics and prognosis of each treatment group. Result. Patients receiving chemotherapy and palliative treatment only eventually had significantly higher ratios of stoma creation compared to patients who were treated with surgery (colectomy and synchrous colectomy and hepatectomy) (p = 0.0002). Compared with the chemotherapy group, a significantly higher percentage of patients in the surgery group (colectomy, synchronus colectomy and hepatectomy) achieved cures (30% and 100% vs. 1.59%; p ＜ 0.0001). Although the surgery group (colectomy and synchronus colectomy and hepatectomy) had better cancer- specific survival rates than did those in the chemotherapy and palliative therapy only groups, there was no statistical significance between the colectomy group and the synchronous colectomy and hepatectomy group (p = 0.487). After curative treatment of liver metastases was achieved, there were no statistical differences in disease-free and cancer-specific survival among the three treatment groups. Conclusions. Synchronous colectomy and hepatectomy is safe as an initial treatment for carefully selected patients with colorectal cancer and liver metastases. This approach can avoid tumor-related complications and provides better cancer-specific survival. For patients treated first with chemotherapy, the response of liver metastases to chemotherapy during the first year will determine the final prognosis.
並列摘要
目的：該回顧性研究目的，是要分析大腸癌同時合併肝轉移接受不同起始治療方式的預後。方法：從2008年1月至2012年12月，在奇美醫學中心有273位被診斷為大腸直腸癌同時合併肝轉移的患者，排除肝臟外轉移以及腹膜轉移後，最後有150名患者列入本研究。依照不同起始治療方式分成4組，分別有40名病人起始治療為先切除原發大腸癌；15名病人起始治療為同時手術切除大腸癌與肝臟轉移；63名病人起始治療為化學治療；32名病人接受緩解性治療。我們分析比較各組的臨床病理特徵及其治療結果。結果：化學治療組和緩解性治療組比起手術組(包括先切除原發大腸癌組和同時切除大腸癌與肝臟轉移組)有比較高的機率接受腸造口手術。手術治療組(先切除原發大腸癌組和同時切除大腸癌與肝臟轉移組)比化學治療組在統計學上有較高的機率能達到根治性治療(30%，100%比1.59%，p值 ＜ 0.0001)。雖然手術組(先切除原發大腸癌組和同時切除大腸癌與肝臟轉移組)比化學治療組和緩解性治療組具有更好的癌症相關生存率，但在先切除原發大腸癌組和同時切除大腸癌與肝臟轉移組之間相比，並達統計學上差異 (p = 0.487)。達到肝轉移治癒性治療後，這三組在無疾病和癌症特異性生存率上並沒統計學上差異。結論：在小心篩選病人的情況下，手術切除(同時切除原發大腸癌與肝轉移)是安全的，且可以避免腫瘤相關併發症，提供更好的癌症相關生存率。對於先接受化療的病人，第一年肝轉移對化療的反應決定了最終預後。
參考文獻
延伸閱讀
- Huang, H. C., Wang, H. M., Chen, J. B., Chou, D. S., Mar, H. F., Chen, C. C., Chiang, F. F., Chen, M. C., Twu, C. M., & Chen, Y. H. (2011). 使用Oxaliplatin為基礎的術前同步化放療於治療低位進行期直腸癌的優勢. 中華民國大腸直腸外科醫學會雜誌, 22(2), 31-38. https://doi.org/10.6312/SCRSTW.2011.22(2).09916
- Yang, J. F., Lo, C. H., Lin, C. S., Chao, H. L., Lin, K. T., Chen, C. M., & Huang, W. Y. (2017). 肝癌合併門靜脈腫瘤栓塞以立體定位消融放射治療之臨床結果及預後因子分析. 放射治療與腫瘤學, 24(1), 13-23. https://doi.org/10.6316/TRO/201724(1)13
- Chiang, J. M., Chiang, S. F., Hsieh, P. S., Yeh, C. Y., You, J. F., Huang, H. Y., 蔡文司, Chen, J. S., 游耀東, & Tang, R. (2018). 比較不同家族史對於結直腸癌病人之臨床病理特徵，異時性結直腸癌的風險及術後存活之影響. 中華民國大腸直腸外科醫學會雜誌, 29(1), 45-55. https://doi.org/10.6312/SCRSTW.2018.29(1).10624
- Huang, C. C., Jao, S. W., Wu, C. C., Lee, C. C., Lee, T. Y., & Hsiao, C. W. (2013). 直腸癌患者接受術前同步放射及化學治療後有達到與未達到病理完全緩解的臨床預後之比較：在台灣單一機構的回顧性分析. 中華民國大腸直腸外科醫學會雜誌, 24(4), 103-111. https://doi.org/10.6312/SCRSTW.2013.24(4).10206
- Han-Tse Kuo、Wen-Ko Tseng、Yen-Lin Yu、Yu-Hsuan Liu、Yu-Wei Liaw、Chung-Wei Feng（2022）。局部大腸癌經快速術前準備之治療的短期與長期預後分析－單一機構經驗。中華民國大腸直腸外科醫學會雜誌，33(4)，221-229。https://doi.org/10.6312/SCRSTW.202212_33(4).11126