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題 名 | Colorectal Cancer with Resectable Liver Metastases: Surgical Resection, Radiofrequency Ablation, or Stereotactic Body Radiotherapy: Clinical Outcomes of Different Treatment Modalities=大腸直腸癌併可切除的肝轉移:使用手術切除、燒灼術、放射治療等三種的治療方式分析臨床的預後結果 |
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作 者 | 陳憲霖; 何宗翰; 周家麟; 鄭立勤; 林立青; 郭珍妮; 鄭華銘; 吳仁宏; 郭禹廷; 田宇峯; | 書刊名 | 中華民國大腸直腸外科醫學會雜誌 |
卷 期 | 27:4 2016.12[民105.12] |
頁 次 | 頁169-178 |
分類號 | 416.245 |
關鍵詞 | 大腸直腸癌併肝轉移; 肝切除術; 電燒灼術; 放射治療; Colorectal cancer with liver metastasis; Liver resection; Radiofrequency ablation; Stereotactic body radiotherapy; |
語 文 | 英文(English) |
中文摘要 | 目的大腸癌同時合併可切除的肝轉移應該被獨立出來討論,多種的治療模式可延長病人的存活及降低復發機率。為了研究此類病患臨床治療預後的比較,我們從一個單一機構提出回顧性的研究。方法蒐集從2008年1月至2014年12月診斷為大腸直腸癌同時合併可切除的肝轉移的患者。在切除完大腸直腸癌後,藉由三種不同的治療處理肝轉移,來分析比較各自的術後併發症,局部復發,及預後結果。結果總共有75名大腸直腸癌同時合併可切除的肝轉移病患,其中包含47例男性,28例女性,他們的平均年齡為63.11±11.53歲(範圍:35-87歲)。有52位病患接受肝切除手術,有14位病患接受肝腫瘤燒灼術,另有9位病患接受放射治療。在這三個不同治療方式中,以接受放射治療的族群平均年紀較大。在治療後的併發症及局部復發率,這三組並無統計學上顯著差異,但是手術切除有稍微較高的處置後併發症及較低的局部復發率。在無疾病復發狀態分析上,手術切除組別有較長時間的無疾病復發狀態,且在兩年追蹤下的無疾病復發是明顯優於電燒灼術及放射治療族群(p值=0.0004)。在多變異分析下,肝轉移的治療模式是唯一的預後因子。在與癌症相關的存活時間上,手術切除與電燒灼術是明顯優於放射治療,而手術切除和電燒灼術雖沒有明顯統計上差異,但手術切除仍有較長的癌症相關存活時間。結論手術切除仍是大腸直腸癌併可切除肝轉移病患的首選。電燒灼術有較優於放射治療的臨床結果,因此電燒灼術可以在特定病患作為治療,比方說不適合手術治療或全身麻醉的病患。放射治療目前僅使用於狀況更差患者,用來作為緩和性治療為主。 |
英文摘要 | Purpose. Management of patients with synchronous colorectal cancer with liver metastases (CLM) should be individually tailored. We aimed to identify differences in clinical outcomes among different treatment modalities for the treatment of resectable synchronous CLM. Methods. Between 2008 and 2014, 75 patients were diagnosed with resectable synchronous CLM and underwent colorectal resection at the Chi-Mei Medical Center. Among these patients, 52 patients underwent a simultaneous liver resection; 14 patients underwent radiofrequency ablation (RFA); and 9 patients underwent stereotactic body radiotherapy (SBRT) for liver metastases. We compared the clinicopathologic characteristics, posttreatment complications, marginal recurrence, and prognosis patients treated with different modalities. Results. There was no difference in gender, comorbidity, primary tumor size/location, or number of liver metastases among the 3 groups. The mean age was older in the SBRT group (p = 0.0431), and the preoperative CEA level was lower in the RFA group (p = 0.0292). Although there was no difference in the complication rate or marginal recurrence rate among these groups, the liver resection group had a higher complication rate and lower marginal recurrence rate. The liver resection group had a longer disease- free duration (14.94 ± 11.72 months, p = 0.0035) and better 2-year probability of disease-free survival (34.07%, p = 0.0004) compared with the RFA and SBRT groups. Using univariate and multivariate Cox proportional hazard regression analyses, the CLM treatment type was an independent prognostic factor of disease-free survival. Conclusions. Outcomes with RFA and SBRT in CLM have included higher local marginal recurrence rates. If feasible, resection of liver metastases is the best treatment choice. Furthermore, as compared with the outcomes in the SBRT group, use of RFAhad good outcomes; as such, this treatment should be considered for select patients. SBRT should be considered a palliative treatment now. |
本系統中英文摘要資訊取自各篇刊載內容。