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Proposal of a new and simple staging system of colorectal liver metastasis

World Journal of Gastroenterology 2006年第43期12卷 6961-6965页

作者： Ikuo Nagashima Tadahiro Takada Hirokazu Nagawa Tetsuichiro Muto kota okinaga Department of Surgery Teikyo University School of Medicine Tokyo Japan Department of Surgical Oncology Graduate School of Medicine University of Tokyo Tokyo Japan

AIM: To create a new, simple and useful staging system for colorectal liver metastasis analogous to the Tumor Node Metastasis classification system of International Union Against Cancer. METHODS: A retrospective review was undertaken of 81 consecutive patients who underwent partial hepatec- tomy for colorectal liver metastases (group 1). Clinical and pathological features of both primary and metastatic liver cancers were entered into a multivariate analysis to determine independent variables helpful in accurately predicting long-term prognosis after hepatectomy. Using selected variables, we created a new staging system like TNM classification. The usefulness of the new staging system was examined in a series of 92 patients from an- other hospital (group 2). RESULTS: Multivariate analysis showed that 81 patients in group 1 had significant multiple hepatic tumors with the largest tumor being more than 5 cm in diameter, resectable extrahepatic distant metastases, and inde- pendent prognostic factors for poor survival after hepa- tectomy. Using these three variables, we created a new staging system to classify patients with colorectal liver metastases. Finally, our new staging system classified the patients both in group 1 and in group 2. CONCLUSION: Our new staging system of colorectal liver metastasis is simple and useful for staging patients.

关键词：结直肠癌肿瘤转移病理学临床

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Proposal of criteria to select candidates with colorectal liver metastases for hepatic resection:Comparison of our scoring system to the positive number of risk factors

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World Journal of Gastroenterology 2006年第39期12卷 6305-6309页

作者： Ikuo Nagashima Tadahiro Takada Miki Adachi Hirokazu Nagawa Tetsuichiro Muto kota okinaga Department of Surgery Teikyo University School of Medicine Tokyo Japan Department of Surgical Oncology University of Tokyo Graduate School of Medicine Tokyo Japan

AIM: To select accurately good candidates of hepatic resection for colorectal liver metastasis. METHODS: Thirteen clinicopathological features, which were recognized only before or during surgery, were selected retrospectively in 81 consecutive patients in one hospital (GroupⅠ). These features were entered into a multivariate analysis to determine independent and significant variables affecting long-term prognosis after hepatectomy. Using selected variables, we created a scoring formula to classify patients with colorectal liver metastases to select good candidates for hepatic resection. The usefulness of the new scoring system was examined in a series of 92 patients from another hospital (Group Ⅱ), comparing the number of selected variables. RESULTS: Among 81 patients of GroupⅠ, multivariate analysis, i.e. Cox regression analysis, showed that multiple tumors, the largest tumor greater than 5 cm in diameter, and resectable extrahepatic metastases were significant and independent prognostic factors for poor survival after hepatectomy (P < 0.05). In addition, these three factors: serosa invasion, local lymph node metastases of primary cancers, and post- operative disease free interval less than 1 year including synchronous hepatic metastasis, were not significant, however, they were selected by a stepwise method of Cox regression analysis (0.05 < P < 0.20). Using these six variables, we created a new scoring formula to classify patients with colorectal liver metastases. Finally, our new scoring system not only classified patients in GroupⅠvery well, but also that in Group Ⅱ, according to long-term outcomes after hepatic resection. The positive number of these six variables also classified them ***: Both, our new scoring system and the positive number of significant prognostic factors are useful to classify patients with colorectal liver metastases in the preoperative selection of good candidates for hepatic resection.

关键词：结肠癌直肠癌肝移植病理机制

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