大肠癌肝转移综合治疗进展ppt课件

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1、LiverMetastasesofColorectalCancer:Wherearewestandingincurrentpractice?大肠癌肝转移综合治疗进展郝纯毅季加孚北京肿瘤医院外科我的老婆和丈母娘BreastcancerWithpositiveAxillarylymphnodesColorectalcancerWithLivermetastasesDifferent?Similar!15~25％patientswithprimaryCRCpresentwithsynchronouslivermetastasesAnadd

2、itional20%willdevelopmetachronoushepaticsecondaries20%arecandidatesforcurativeresectionoflivermetastasesU.S.150000newcases20000~30000China500000newcases70000~100000EPIDEMIOLOGYauthoryearpatientsopmortality5yearsuvival#(%)(%)Adson19841412.823Hugues1986859533Nordlinger1987

3、80525Nordlinger199615682.326Fong199910012.837Yamamoto199996━51Minagawa*2000235038Scheele20015165.838OverallResultsofHepaticResectionforCRCMetastasesLongtermresults(Frenchstudy,n=1985)5yearsurvivalOverall26%Confinedtoliver28%Withextrahepaticextension15%Positivenodes12%Pal

4、liativeresections0%OverallSurvivalafterResection(FrenchStudy)LiveronlyOverallSurvival-DiseaseFreeSurvival(Frenchstudy)PrognosticFactorsafterR0-resection(Ｉ)Demographicfeatures:gender,agePrimarytumor:LNinvolvement,size,differentiation,stagingandlocation(espinsychronousmeta

5、stases)Metastases:multiplicityoflesionsandtheintrahepatictumordistribution?SatellitemetastasesSizeoftumorHistopatholigicalfeaturesSynchronousandmetachronousmetastasesPrognosticFactorsafterR0-resection(Ⅱ)TherapeuticapproachOthers:PS,weightloss,serumalbumin,preoperativeCEA

6、,tumorploidy,oncogen/oncosupressorgeneexpression,etc.SurgeonperformingtheoperationPrognosticFactorsInfluencingSurvivalandRecurrences(FrenchStudy)RiskFactorsRelativeRiskPrimarytumor:serosa+1.4Primarytumor:N+1.5Delay(primarytometastase)<2years1.4Numberofmetastases>31.6Rese

7、ctionclearance<1cm1.4Sizeofmetastases>5cm1.3Age>60yrs1.2PlasmaCEA>30ng/ml2.2SurvivalAccordingtoNumberofRiskFactorsNordlingerB.Cancer1996;77:1254-620-276%01008060402052103years43-459%5-744%*FongY.AnnSurg1999;230:309-321SurvivalAccordingtotheNumberofMetastases0100806040206

8、02412036Months48ONE42%TWOtoTHREE30%MOREthanFOUR23%ProbabilityofsuvivalyearsfromR0resection1098765432101