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目的探讨Ⅳ期结直肠癌姑息性手术治疗效果和影响预后的因素。方法回顾性分析1999年8月至2004年3月诊治的78例Ⅳ期结直肠癌患者的临床病理资料。结果姑息性手术治疗组73例,未手术组5例。全组患者中位生存时间11个月。单因素分析显示:原发灶切除,肿瘤合并症,肿瘤转移范围,CEA水平,是否接受化疗等因素与预后相关。Cox多因素分析仅显示肿瘤多发性转移、CEA水平升高和未化疗是Ⅳ期结直肠癌的独立危险因素。分析53例无肿瘤外科合并症患者的预后因素,原发灶切除组和未切除组的中位生存时间分别是12个月和10个月,预后差异无统计学意义(P=0．1568),而肿瘤转移范围,CEA水平,是否接受化疗是患者生存的独立相关因素。结论对结直肠癌原发肿瘤引起的肠梗阻、消化道出血等合并症者,应争取积极手术切除;无外科合并症患者切除原发肿瘤并不能改善Ⅳ期结直肠癌患者的预后。
Objective To investigate the effect of palliative surgery for stage Ⅳ colorectal cancer and its prognostic factors. Methods The clinical data of 78 patients with stage Ⅳ colorectal cancer diagnosed and treated from August 1999 to March 2004 were retrospectively analyzed. Results Palliative surgery group 73 cases, 5 cases without surgery group. The median survival time of all patients was 11 months. Univariate analysis showed that factors such as primary tumor resection, tumor complication, tumor metastasis range, CEA level, chemotherapy and prognosis were related to prognosis. Cox multivariate analysis showed only multiple tumor metastases, elevated CEA levels and no chemotherapy were independent risk factors for stage IV colorectal cancer. The prognostic factors of 53 patients without tumor surgery complications were analyzed. The median survival time of primary resection group and non-resection group was 12 months and 10 months, respectively, with no significant difference in prognosis (P = 0.1568) , While the extent of tumor metastasis, CEA level, whether chemotherapy is an independent relevant factor for survival of patients. Conclusion For patients with colorectal cancer caused by intestinal obstruction, gastrointestinal bleeding and other complications, should be scored for active surgical resection; surgical complications in patients with primary tumor resection does not improve the prognosis of patients with stage Ⅳ colorectal cancer.