JAMA Surg:肝移植 vs 门静脉栓塞术后肝切除对高肿瘤负担的结肠癌肝转移患者生存期的影响

2021-04-14 MedSci原创 MedSci原创

对于高肿瘤负担的结肠癌肝转移患者,肝移植后患者5年生存率远高于门静脉栓塞术后肝切除

西方国家中,结直肠癌是发病率第二高肿瘤。约50%的结肠癌患者在确诊时或治疗后会出现转移,其中肝转移的比例最高。对于结肠癌肝转移患者(CRLM),肝切除术(LR)是首选治疗手段,但实践中符合LR要求的CRLM患者比例较低,主要因素是剩余肝脏体积(FLR)不足导致术后肝衰竭风险。近年来,门静脉栓塞术(PVE)后LR在已在众多结直肠癌肝转移患者中得到应用,是代替肝移植的广泛性肝脏疾病治疗方法,患者术后5年总生存率约30-50%。肿瘤负担是预测CRLM患者术后生存期的重要手段,主要的影响因素包括最大病变体积(是否超过5cm)和转移性病灶数量。

近日研究人员比较了对于结直肠癌并伴有高肿瘤负担的肝转移患者,接受肝移植或PVE后LR的总生存率(OS)差异

50名结肠癌肝转移患者参与研究,于2006-19年间在挪威奥斯陆大学医院参与肝移植研究,以另外53名奥斯陆大学医院PVE数据库患者为对照,上述患者具有相似的基线特征,接受了PVE后肝切除术或肝移植。研究的主要终点为高肿瘤负担患者,接受肝移植,PVE后肝切除数对OS的影响,高肿瘤负担的定义为存在9个或更多的转移性肿瘤或直径为5.5cm或更大的最大肝脏病变。

PVE组53名患者中,平均年龄为61.8岁,男性36例(68%)。PVE后肝切除术后5年OS率为44.6%。在高肿瘤负担患者中,肝移植组5年OS率33.4%,PVE-肝切除组仅为6.7%。在肿瘤负担高且左侧原发性肿瘤患中,肝移植组5年OS率为45.3%,而PVE-肝切除组为12.5%。

研究发现,对于高肿瘤负担的结肠癌肝转移患者,肝移植后患者5年生存率远高于门静脉栓塞术后肝切除

原始出处:

Svein Dueland et al. Survival Outcomes After Portal Vein Embolization and Liver Resection Compared With Liver Transplant for Patients With Extensive Colorectal Cancer Liver Metastases.JAMA Surg. March 31, 2021.

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    2021-11-16 ms1000000449881602

    非常感谢梅斯医学让我有效率地找到这么多有效的信息,为家人治疗癌症提供背景知识,能够和医生进行有效沟通。已经被多次问到你是不是学医的。可惜我不是,发现不是医疗机构就不能注册验证呢。

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topicName=null, topicId=null, topicList=[TopicDto(id=69004, encryptionId=c29b69004f9, topicName=生存期)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e68e415, createdName=juliusluan78, createdTime=Fri Apr 16 12:04:17 CST 2021, time=2021-04-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1435180, encodeId=19c714351800a, content=<a href='/topic/show?id=6d779e14916' target=_blank style='color:#2F92EE;'>#门静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97149, encryptionId=6d779e14916, topicName=门静脉)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Fri Apr 16 12:04:17 CST 2021, time=2021-04-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1443865, encodeId=709a1443865d5, content=<a href='/topic/show?id=6b058150307' target=_blank style='color:#2F92EE;'>#肝转移#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81503, encryptionId=6b058150307, topicName=肝转移)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ea155117075, createdName=ms6747015003810650, createdTime=Fri Apr 16 12:04:17 CST 2021, time=2021-04-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=957378, encodeId=e80c95e3786e, content=肝移植对结肠癌肝转移患者生存期, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210110/e6124a4b19bc40ce8afaae096d21126b/dd778ac260c9416eb87e7d08139507f5.jpg, createdBy=4d2f5079605, createdName=科研科研科研, createdTime=Thu Apr 15 19:44:42 CST 2021, time=2021-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=957136, encodeId=72d895e13645, content=三人行,必有我师。 <a href='/topic/show?id=d55f104233bd' target=_blank style='color:#2F92EE;'>#梅斯医学科研互助群#</a> 欢迎您的加入,添加【梅斯医学科研助手WeChat:medsci_2021】邀您进群! 【社群简介】👉 梅斯医学目前已建立覆盖肿瘤、心血管、神经、消化、内分泌、呼吸等30个科室的学习交流社群。 【入群福利】👉 群内可实时交流病例,提问同行,跨群讨论,每天更新前沿医学资讯和指南共识,每周推出至少1场专业直播,不时共享科研干货,入群即可获得100份SCI写作攻略!, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=104233, encryptionId=d55f104233bd, topicName=梅斯医学科研互助群)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210413/08ec7710e47c4f6dba6c277207bf00ec/823f09e953ea44188e56b38cd2f16334.jpg, createdBy=ec565230154, createdName=梅干儿, createdTime=Thu Apr 15 00:06:13 CST 2021, time=2021-04-15, status=1, ipAttribution=)]
    2021-11-03 fusion
  4. [GetPortalCommentsPageByObjectIdResponse(id=1932693, encodeId=ea9d193269375, content=<a href='/topic/show?id=5cd95305803' target=_blank style='color:#2F92EE;'>#患者生存#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53058, encryptionId=5cd95305803, topicName=患者生存)], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=47c5349, createdName=tastas, createdTime=Fri Oct 08 02:04:17 CST 2021, time=2021-10-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1070889, encodeId=dac210e08893a, content=非常感谢梅斯医学让我有效率地找到这么多有效的信息,为家人治疗癌症提供背景知识,能够和医生进行有效沟通。已经被多次问到你是不是学医的。可惜我不是,发现不是医疗机构就不能注册验证呢。, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=41265542375, 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createdTime=Thu Apr 15 19:44:42 CST 2021, time=2021-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=957136, encodeId=72d895e13645, content=三人行,必有我师。 <a href='/topic/show?id=d55f104233bd' target=_blank style='color:#2F92EE;'>#梅斯医学科研互助群#</a> 欢迎您的加入,添加【梅斯医学科研助手WeChat:medsci_2021】邀您进群! 【社群简介】👉 梅斯医学目前已建立覆盖肿瘤、心血管、神经、消化、内分泌、呼吸等30个科室的学习交流社群。 【入群福利】👉 群内可实时交流病例,提问同行,跨群讨论,每天更新前沿医学资讯和指南共识,每周推出至少1场专业直播,不时共享科研干货,入群即可获得100份SCI写作攻略!, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=104233, encryptionId=d55f104233bd, topicName=梅斯医学科研互助群)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210413/08ec7710e47c4f6dba6c277207bf00ec/823f09e953ea44188e56b38cd2f16334.jpg, createdBy=ec565230154, createdName=梅干儿, createdTime=Thu Apr 15 00:06:13 CST 2021, time=2021-04-15, status=1, ipAttribution=)]
    2021-04-24 changfy
  5. 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createdTime=Thu Apr 15 19:44:42 CST 2021, time=2021-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=957136, encodeId=72d895e13645, content=三人行,必有我师。 <a href='/topic/show?id=d55f104233bd' target=_blank style='color:#2F92EE;'>#梅斯医学科研互助群#</a> 欢迎您的加入,添加【梅斯医学科研助手WeChat:medsci_2021】邀您进群! 【社群简介】👉 梅斯医学目前已建立覆盖肿瘤、心血管、神经、消化、内分泌、呼吸等30个科室的学习交流社群。 【入群福利】👉 群内可实时交流病例,提问同行,跨群讨论,每天更新前沿医学资讯和指南共识,每周推出至少1场专业直播,不时共享科研干货,入群即可获得100份SCI写作攻略!, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=104233, encryptionId=d55f104233bd, topicName=梅斯医学科研互助群)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210413/08ec7710e47c4f6dba6c277207bf00ec/823f09e953ea44188e56b38cd2f16334.jpg, createdBy=ec565230154, createdName=梅干儿, createdTime=Thu Apr 15 00:06:13 CST 2021, time=2021-04-15, status=1, ipAttribution=)]
    2021-04-22 科研科研科研

    生存期的影响

    0

  6. 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encryptionId=a6ba8118009, topicName=肝切除)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=32d177, createdName=changfy, createdTime=Sat Apr 24 06:04:17 CST 2021, time=2021-04-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=959484, encodeId=f39b959484b3, content=生存期的影响, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210110/e6124a4b19bc40ce8afaae096d21126b/dd778ac260c9416eb87e7d08139507f5.jpg, createdBy=4d2f5079605, createdName=科研科研科研, createdTime=Thu Apr 22 18:41:28 CST 2021, time=2021-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1378285, encodeId=153813e828555, content=<a href='/topic/show?id=c29b69004f9' target=_blank style='color:#2F92EE;'>#生存期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=69004, encryptionId=c29b69004f9, topicName=生存期)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e68e415, createdName=juliusluan78, createdTime=Fri Apr 16 12:04:17 CST 2021, time=2021-04-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1435180, encodeId=19c714351800a, content=<a href='/topic/show?id=6d779e14916' target=_blank style='color:#2F92EE;'>#门静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97149, encryptionId=6d779e14916, topicName=门静脉)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Fri Apr 16 12:04:17 CST 2021, time=2021-04-16, status=1, ipAttribution=), 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createdTime=Thu Apr 15 19:44:42 CST 2021, time=2021-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=957136, encodeId=72d895e13645, content=三人行,必有我师。 <a href='/topic/show?id=d55f104233bd' target=_blank style='color:#2F92EE;'>#梅斯医学科研互助群#</a> 欢迎您的加入,添加【梅斯医学科研助手WeChat:medsci_2021】邀您进群! 【社群简介】👉 梅斯医学目前已建立覆盖肿瘤、心血管、神经、消化、内分泌、呼吸等30个科室的学习交流社群。 【入群福利】👉 群内可实时交流病例,提问同行,跨群讨论,每天更新前沿医学资讯和指南共识,每周推出至少1场专业直播,不时共享科研干货,入群即可获得100份SCI写作攻略!, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=104233, encryptionId=d55f104233bd, topicName=梅斯医学科研互助群)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210413/08ec7710e47c4f6dba6c277207bf00ec/823f09e953ea44188e56b38cd2f16334.jpg, createdBy=ec565230154, createdName=梅干儿, createdTime=Thu Apr 15 00:06:13 CST 2021, time=2021-04-15, status=1, ipAttribution=)]
  7. 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topicName=null, topicId=null, topicList=[TopicDto(id=69004, encryptionId=c29b69004f9, topicName=生存期)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e68e415, createdName=juliusluan78, createdTime=Fri Apr 16 12:04:17 CST 2021, time=2021-04-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1435180, encodeId=19c714351800a, content=<a href='/topic/show?id=6d779e14916' target=_blank style='color:#2F92EE;'>#门静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97149, encryptionId=6d779e14916, topicName=门静脉)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Fri Apr 16 12:04:17 CST 2021, time=2021-04-16, status=1, ipAttribution=), 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createdTime=Thu Apr 15 19:44:42 CST 2021, time=2021-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=957136, encodeId=72d895e13645, content=三人行,必有我师。 <a href='/topic/show?id=d55f104233bd' target=_blank style='color:#2F92EE;'>#梅斯医学科研互助群#</a> 欢迎您的加入,添加【梅斯医学科研助手WeChat:medsci_2021】邀您进群! 【社群简介】👉 梅斯医学目前已建立覆盖肿瘤、心血管、神经、消化、内分泌、呼吸等30个科室的学习交流社群。 【入群福利】👉 群内可实时交流病例,提问同行,跨群讨论,每天更新前沿医学资讯和指南共识,每周推出至少1场专业直播,不时共享科研干货,入群即可获得100份SCI写作攻略!, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=104233, encryptionId=d55f104233bd, topicName=梅斯医学科研互助群)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210413/08ec7710e47c4f6dba6c277207bf00ec/823f09e953ea44188e56b38cd2f16334.jpg, createdBy=ec565230154, createdName=梅干儿, createdTime=Thu Apr 15 00:06:13 CST 2021, time=2021-04-15, status=1, ipAttribution=)]
  8. [GetPortalCommentsPageByObjectIdResponse(id=1932693, encodeId=ea9d193269375, content=<a href='/topic/show?id=5cd95305803' target=_blank style='color:#2F92EE;'>#患者生存#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53058, encryptionId=5cd95305803, topicName=患者生存)], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=47c5349, createdName=tastas, createdTime=Fri Oct 08 02:04:17 CST 2021, time=2021-10-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1070889, encodeId=dac210e08893a, content=非常感谢梅斯医学让我有效率地找到这么多有效的信息,为家人治疗癌症提供背景知识,能够和医生进行有效沟通。已经被多次问到你是不是学医的。可惜我不是,发现不是医疗机构就不能注册验证呢。, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=41265542375, 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createdTime=Thu Apr 15 19:44:42 CST 2021, time=2021-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=957136, encodeId=72d895e13645, content=三人行,必有我师。 <a href='/topic/show?id=d55f104233bd' target=_blank style='color:#2F92EE;'>#梅斯医学科研互助群#</a> 欢迎您的加入,添加【梅斯医学科研助手WeChat:medsci_2021】邀您进群! 【社群简介】👉 梅斯医学目前已建立覆盖肿瘤、心血管、神经、消化、内分泌、呼吸等30个科室的学习交流社群。 【入群福利】👉 群内可实时交流病例,提问同行,跨群讨论,每天更新前沿医学资讯和指南共识,每周推出至少1场专业直播,不时共享科研干货,入群即可获得100份SCI写作攻略!, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=104233, encryptionId=d55f104233bd, topicName=梅斯医学科研互助群)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210413/08ec7710e47c4f6dba6c277207bf00ec/823f09e953ea44188e56b38cd2f16334.jpg, createdBy=ec565230154, createdName=梅干儿, createdTime=Thu Apr 15 00:06:13 CST 2021, time=2021-04-15, status=1, ipAttribution=)]
  9. 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createdTime=Thu Apr 15 19:44:42 CST 2021, time=2021-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=957136, encodeId=72d895e13645, content=三人行,必有我师。 <a href='/topic/show?id=d55f104233bd' target=_blank style='color:#2F92EE;'>#梅斯医学科研互助群#</a> 欢迎您的加入,添加【梅斯医学科研助手WeChat:medsci_2021】邀您进群! 【社群简介】👉 梅斯医学目前已建立覆盖肿瘤、心血管、神经、消化、内分泌、呼吸等30个科室的学习交流社群。 【入群福利】👉 群内可实时交流病例,提问同行,跨群讨论,每天更新前沿医学资讯和指南共识,每周推出至少1场专业直播,不时共享科研干货,入群即可获得100份SCI写作攻略!, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=104233, encryptionId=d55f104233bd, topicName=梅斯医学科研互助群)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210413/08ec7710e47c4f6dba6c277207bf00ec/823f09e953ea44188e56b38cd2f16334.jpg, createdBy=ec565230154, createdName=梅干儿, createdTime=Thu Apr 15 00:06:13 CST 2021, time=2021-04-15, status=1, ipAttribution=)]
    2021-04-15 科研科研科研

    肝移植对结肠癌肝转移患者生存期

    0

  10. 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    2021-04-15 梅干儿

    三人行,必有我师。 #梅斯医学科研互助群# 欢迎您的加入,添加【梅斯医学科研助手WeChat:medsci_2021】邀您进群! 【社群简介】👉 梅斯医学目前已建立覆盖肿瘤、心血管、神经、消化、内分泌、呼吸等30个科室的学习交流社群。 【入群福利】👉 群内可实时交流病例,提问同行,跨群讨论,每天更新前沿医学资讯和指南共识,每周推出至少1场专业直播,不时共享科研干货,入群即可获得100份SCI写作攻略!

    0

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