| Background:Recently, the incidence of colorectal cancer in China showed a rising trend year by year, the incidence has accounted for the fourth place in common cancer; it is rising much faster than 2% of the international standard, and almost equal to 5%. Liver metastases of colorectal cancer is extremely common,20-40% patients have liver metastases at the time of diagnosis. The incidence of delayed liver metastasis is up to 50%. Liver metastatic is a leading cause of death in patients with metastatic colorectal cancer.5-year survival rate of patients who accept Surgery can be 25%-55%. However, there are still 80-85% of the transferred liver can not be removed. Thanks to the application of new drugs and improved treatment mode, the median survival of patients with metastatic colorectal cancer has been extended to 24 months.67 cases patients with metastatic colorectal cancer from September 2003 to December 2008 were collected in the Second Affiliated Hospital of Dalian Medical University, In this study, we analyze these data with statistical method to investigate the prognostic factors and treatment law of patients with metastatic colorectal cancer, and further to provide empirical laws for the clinical therapy.Objective:To investigate the prognostic factors and treatment for liver metastasis of colorectal cancer.Method:Analysis the clinical data of 67patients with liver metastases of colorectal cancer retrospectively, survival data use Kaplan-Meier method, find the median overall survival time and 1,2,3-year cumulative survival rate, use log-rank test for single-factor analysis. variables that were associated on single-variable analysis with significant differences in Kaplan-Meier survival analysis were entered into a multivariate COX regression to find out independent prognostic factors; two independent samples whose means Obey normal distribution use t test, the rate use x2 test, And then identify the treatment law for clinical therapy.Result:1. The median overall survival time of 67 patients was (21.3±2.9) months, while after liver metastases was (10±1.5) months. Synchronous liver metastasis and delayed liver metastasis after the diagnosis has no significant difference in survival. The survival curve of patients with colorectal cancer will be flat after two years. The survival curve of patients with liver metastasis will be flat after a year.2. Kaplan-Meier single-variable analysis showed that primary tumor morphology, pathological type, differentiation degree, stage, regional lymph node metastasis, synchronous liver metastasis or not, whether with peritoneal fluid or drug chemotherapy, and the number of drugs were statistically significant prognostic factors. COX proportional hazard models showed that the primary tumor differentiation, synchronous liver metastasis or not, with or without chemotherapy, with or without peritoneal fluid are independent prognostic indicator.3. After Liver metastasis, the Kaplan-Meier single-variable analysis showed that the number of liver metastasis, maximum diameter of liver metastases, treatment mode of hepatic metastasis and the number of other distant metastasis were statistically significant prognostic factors. COX regression analysis showed that the above-mentioned four factors in patients with liver metastasis were independent prognostic factors.4. T test results showed that the time to progression (TTP) of group L-OHP+5-FU is 5.6±1.79 months, group CPT-11+5-FU is 4.07±0.82 months, the two was no statistical significance; x2 test results showed that there was no significant difference in efficient and the rate of disease control.Conclusion:1. Synchronous liver metastasis and delayed liver metastasis after the diagnosis has no significant difference in survival. Two years after diagnosis, the risk of death will be reduced of patients with colorectal cancer; the time with liver metastasis is a year.2. Patients with better tumor differentiation, without peritoneal fluid, with chemotherapy (three drugs is superior to two drugs and a single drug) have longer survival. Patients with single liver metastasis which maximum diameter<5cm and have fewer other distant metastases will have a long-term survival. Local treatment combined with systematic chemo-therapy is superior to a single therapy.3. Chemotherapy should be used with caution in elderly patients (age≥70).4. The group L-OHP+5-FU and the group CPT-11+5-FU both can be first-line and second-line therapy. |
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