Медицинская литература. Новинки

 

 

 

 

 

 

Анализ отдаленных результатов комбинированного лечения больных метастазами колоректального рака в печени с использованием международной базы данных LiverMetSurvey

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Международная база данных LiverMetSurvey была создана для анализа хирургического лечения пациентов с метастазами колоректального рака в печени и включает информацию о 16 779 больных из разных стран мира. В РНЦХ РАМН оперировано 272 пациента. Сравнительный анализ выживаемости проводили по 8 признакам. Наилучшие показатели четырехлетней выживаемости в обеих базах данных были при условии локализации метастазов в одной доле, метастазах до 30 мм, числе не более 3 и отсутствии внепеченочного распространения. В РНЦХ чаще диагностировали распространенные формы заболевания, что у 35% больных потребовало дополнительных методов хирургического лечения (по сравнению с 22% в LiverMetSurvey). Предоперационная химиотерапия не ухудшала отдаленный прогноз у пациентов РНЦХ: четырехлетняя выживаемость составила 34,7% по сравнению с 35,3% без химиотерапии (р = 0,247). По данным международного анализа лекарственная терапия имела прогностическое значение, уменьшая выживаемость с 53 до 48% (р 0,0001). Отдаленные результаты после использования комбинированных хирургических методов (радиочастотной термодеструкции и окклюзирующих операций) были сравнимы с группой больных, в которой их не применяли. В LiverMetSurvey четырехлетняя выживаемость была меньше, если резекцию дополняли радиочастотной абляцией (43% по сравнению с 52, р 0,0001) или проводили 2*м этапом после окклюзирующей операции (39% и 52%; р 0,0001). Результаты проведенного анализа свидетельствуют о достаточно высоком уровне оказания хирургической помощи в отдельном российском центре.

Ключевые слова:
колоректальный рак, метастазы, выживаемость, отдаленные результаты, комбинированное лечение, химиотерапия.

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Analysis of LongTerm Results of Colorectal Cancer Liver Metastasis Patients Applying International Data Base LiverMetSurvey

The international database LiverMetSurvey was created for analysis of surgical treatment in patients with colorectal liver metastasizes. It includes information about 16 779 patients from the different countries of the world. 272 patients were operated and analysed in the RNRCS of RAMSci. The comparative analysis of survival rate was carried out on 8 factors. The highest 4-year survival rate was in patients with unilobar metastasis, which diameter does not exceed 30 mm, total number is not more than three, and there is no evidence for extrahepatic spread. In the RNRCS advanced disease was diagnosed more often, and 35% of patients were treated with additional surgical methods (vs 22% LiverMetSurvey). Preoperative chemotherapy didn't worsen the long-term results in patients from NRCS (4*year survival rate was 34.7% vs 35.3% without chemotherapy, p = 0.247). According to LiverMetSurvey chemotherapy had prognostic value, and reducing the survival rate from 53 % to 48%, p 0.0001. The long*term results after use of the combined surgical methods (RFA and portal vein occlusion) were comparable with group of patients where they did not used. In LiverMetSurvey the 4*year survival rate was lower, if liver resection was combined with RFA (43% vs 52%, p 0.0001) or performed as second stage after portal vein occlusion (39% vs 52 %, p 0.0001). Results of the study showed relative high level of specialised medical care in single surgical center

Keywords:
colorectal cancer, metastasis, survival, long-term results, combined management, chemotherapy