目的:本研究旨在分析同时切除肝转移联合腹腔热灌注化疗(HIPEC)治疗结直肠癌同步肝转移的临床效果。
方法:将我院2018年1月至2019年1月收治的144例结直肠癌同时性肝转移患者随机分为对照组和干预组。对照组患者接受同时切除肝转移瘤。干预组患者同时切除肝转移瘤联合HIPEC。比较2组近期总有效率,计算治疗3个月后2组的疾病控制率。患者随访3年。观察并比较2组的生存时间。采集两组患者的空腹静脉血,与癌胚抗原(CEA)水平进行比较。比较2组患者的生活质量量表(简表36项健康调查)水平和不良反应发生情况。
结果:干预组R0完全切除率明显高于对照组(P<0.05)。干预组近期总有效率(87.50%)明显高于对照组(59.72%)(P<0.05)。干预组CEA阴性变化为72.22%,显著高于对照组的43.06%(χ2=12.542,P<.001)。经过36个月的随访,观察组的总生存率明显高于对照组(风险比,2.54;95%CI,1.05-5.48;P<.001)。干预组患者的健康状况生活质量评分明显高于对照组,社会功能,情感功能,物理功能,心理健康状况优于对照组(P<0.05)。两组并发症发生率比较差异无统计学意义(P>0.05)。年龄>60岁,术前合并症,肿瘤的中度和高度分化,术中失血量>150mL,和手术经验较少是影响患者治疗后并发症发生的危险因素,与患者的预后和生存密切相关(P<0.05)。年龄≤60岁的患者,术前没有合并症,低肿瘤分化,术中失血量≤150mL,更有经验的外科医生,完全R0切除生存时间较长。年龄>60岁,术前合并症,肿瘤的中度和高度分化,术中失血量>150mL,和经验较少的外科医生是影响结直肠癌肝转移患者预后的独立危险因素(P<0.05)。而R0手术是预后的独立保护因素(P<0.05)。
结论:在同步结直肠癌肝转移的治疗中,同时切除肝转移瘤联合HIPEC显示出优异的疗效.这种方法可能会延长患者的生存率并提高生活质量,值得在临床实践中广泛使用。
OBJECTIVE: This
study aimed to analyze the clinical effect of simultaneous resection of liver metastases combined with hyperthermic intraperitoneal chemotherapy (HIPEC) on synchronous colorectal cancer liver metastasis.
METHODS: A total of 144 patients with synchronous colorectal cancer liver metastasis who were admitted to our hospital between January 2018 and January 2019 were randomly assigned into a control group and an intervention group. The patients in the control group received simultaneous resection of liver metastases. The patients in the intervention group obtained simultaneous resection of liver metastases combined with HIPEC. The recent total effective rate of the 2 groups was compared, and the disease control rate of the 2 groups was calculated at 3 months after treatment. The patients were followed up for 3 years. The survival time of the 2 groups was observed and compared. Fasting venous blood was collected from patients in the 2 groups, and the carcinoembryonic antigen (CEA) level was compared. The level of quality of life scale (Short Form 36-item Health Survey) and the occurrence of adverse reactions were compared between the 2 groups.
RESULTS: The R0 complete resection rate in the intervention group was significantly higher than that in the control group (P < .05). The recent total effective rate in the intervention group (87.50%) was significantly higher than that in the control group (59.72%) (P < .05). The negative change of CEA in the intervention group was 72.22%, which was prominently higher than that in the control group of 43.06% (χ2 = 12.542, P < .001). After a 36-month follow-up, the overall survival rate of the observation group was significantly higher than that of the control group (hazard ratio, 2.54; 95% CI, 1.05-5.48; P < .001). The patients in the intervention group had significantly higher life quality scores of health status, social function, emotional function, physical function, and mental health than in the control group (P < .05). There was no significant difference in the incidence of complications between the 2 groups (P > .05). Age > 60 years, preoperative comorbidities, moderate and high differentiation of tumors, intraoperative blood loss > 150 mL, and less experienced surgeons were risk factors affecting the occurrence of complications after treatment and were closely correlated with the prognosis and survival of patients (P < .05). Patients with age ≤ 60 years, no preoperative comorbidities, low tumor differentiation, intraoperative blood loss ≤ 150 mL, more experienced surgeons, and complete R0 resection had a longer survival time. Age > 60 years, preoperative comorbidities, moderate and high differentiation of tumors, intraoperative blood loss > 150 mL, and less experienced surgeons were independent risk factors affecting the prognosis of patients with colorectal cancer liver metastases (P < .05), whereas R0 surgery was an independent protective factor for the prognosis (P < .05).
CONCLUSIONS: In the treatment of synchronous colorectal cancer liver metastases, simultaneous resection of liver metastases in conjunction with HIPEC demonstrated superior efficacy. This approach may potentially extend patient survival and enhance quality of life and deserve to be extensively used in clinical practice.