77例直肠癌伴肝转移患者的临床预后分析
摘要
目的:探讨影响直肠癌伴肝转移患者预后的相关因素。方法:回顾性分析新疆医科大学第一附属医院2002年1月至2008年12月收治的直肠癌伴肝转移患者77例,用Kaplan-Meier法分析本组患者的总生存率,用Log-rank检验和COX模型(SPSS17.0)对影响生存的13项临床病理因素和临床治疗方法进行单因素和多因素分析。结果:该组患者1年,2年,3年,5年总生存率分别为47.70%,28.80%,13.10%,1.50%。单因素分析结果显示原发肿瘤的分化程度、肠壁浸润、淋巴结转移、肝转移灶分布、肝转移灶数目、肝转移灶最大直径、肝外侵犯或转移、确诊时CEA水平、手术性质为预后影响因素,均有统计学意义(P<0.05);多因素分析显示:原发肿瘤的分化程度(P=0.007)、肠壁浸润(P=0.027)、肝转移灶最大直径(P=0.003)、确诊时CEA水平(P=0.000)为独立的预后因素。结论:对于直肠癌伴肝转移患者,原发肿瘤病理分化程度越高、肠壁浸润越浅、肝转移灶最大直径越小及确诊时CEA水平越低,患者的生存率越高,预后越好。
Objective: To explore the prognostic factors for rectal cancer patients with synchronous liver metastases. Methods: Data from a total of 77 rectal cancer patients with synchronous liver metastases treated at Xinjiang Medical University from January 2002 to December 2008 were collected and reviewed. The total survival rate was analyzed by Kaplan-Meier method, Log-rank method and Cox regression model with SPSS17.0 software were used to analyze 13 factors including clinical pathological factors and treatment choices. Results: The median survival time of 77 patients with synchronous liver metastases from rectal cancer was 12 months. The 1-, 2-, 3-and 5-year survival rates were 47.70%, 28.80%, 13.10%, and 1.50% respectively. Univariate analysis with Kaplan-Meier methods revealed that the differentiation of the primary tumor, T-stage, N status, the distribution、number and size of liver metastases, extrahepatic disease, serum CEA level at diagnosis and treatment modality were prognostic factors(P<0.05). Multivariate analysis showed that the differentiation of the primary tumor(P=0.007), T-stage(P=0.027), the size of liver metastases(P=0.003), serum CEA value at diagnosis(P=0.000) were independent prognostic factors for rectal cancer patients with synchronous liver metastases. Conclusion: The factors affecting the prognosis for rectal cancer patients with synchronous liver metastases are the differentiation of the primary tumor, T-stage, N status, the distribution、number and size of liver metastases,extrahepatic disease, serum CEA level at diagnosis and treatment modality; the independent prongostic factors are the differentiation of the primary tumor, T-stage, the size of liver metastases, serum CEA value at diagnosis.
Objective: To explore the prognostic factors for rectal cancer patients with synchronous liver metastases. Methods: Data from a total of 77 rectal cancer patients with synchronous liver metastases treated at Xinjiang Medical University from January 2002 to December 2008 were collected and reviewed. The total survival rate was analyzed by Kaplan-Meier method, Log-rank method and Cox regression model with SPSS17.0 software were used to analyze 13 factors including clinical pathological factors and treatment choices. Results: The median survival time of 77 patients with synchronous liver metastases from rectal cancer was 12 months. The 1-, 2-, 3-and 5-year survival rates were 47.70%, 28.80%, 13.10%, and 1.50% respectively. Univariate analysis with Kaplan-Meier methods revealed that the differentiation of the primary tumor, T-stage, N status, the distribution、number and size of liver metastases, extrahepatic disease, serum CEA level at diagnosis and treatment modality were prognostic factors(P<0.05). Multivariate analysis showed that the differentiation of the primary tumor(P=0.007), T-stage(P=0.027), the size of liver metastases(P=0.003), serum CEA value at diagnosis(P=0.000) were independent prognostic factors for rectal cancer patients with synchronous liver metastases. Conclusion: The factors affecting the prognosis for rectal cancer patients with synchronous liver metastases are the differentiation of the primary tumor, T-stage, N status, the distribution、number and size of liver metastases,extrahepatic disease, serum CEA level at diagnosis and treatment modality; the independent prongostic factors are the differentiation of the primary tumor, T-stage, the size of liver metastases, serum CEA value at diagnosis.
引文
[1] Glimelius B, Oliveira J. Rectal cancer: ESMO Clinical Recommendations for diagnosis, treatment and follow-up. Annals of Oncology, 2008,19 (Supplement 2):ii31-ii32.
[2]殷蔚伯,谷铣之主编.肿瘤放射治疗学,第4版.北京:中国协和医科大学出版社出版,2007:855.
[3] Nelson H, Petrelli N, Carlin A, et al. Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst, 2001,93:583-596.
[4] Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med, 2001,345:638-646.
[5] Van CE, Nordlinger B, Adam R, et al. Towards a pan-European consensus on the treatment of patients with colorectal liver metastases. Eur J Cancer, 2006, 42: 2212- 2221.
[6] Yoo PS, Lopez RI, Longo WE, et al. Liver resection for metastatic colorectal cancer in the age of neoadjuvant chemotherapy and bevacizumab. Clin Colorectal Cancer, 2006,6:202-207.
[7] Kemeny N. Management of liver metastases from colorectal cancer. Oncology (Williston Park), 2006,20:1161-1176,1179;discussion 1179-1180,1185-1166.
[8] Muratore A, Zorzi D, Bouzari H, et al. Asymptomatic colorectal cancer with re-resectable liver metastases: immediate colorectal resection or up-front systemic chemotherapy? Ann Surg Oncol, 2007,14:766-770.
[9] Alberts SR, Horvath WL, Sternfeld WC, et al. Oxaliplatin, fluorouracil, and leucovorin for patients with unresectable liver-only metastases from colorectal cancer: a North Central Cancer Treatment Group phaseⅡstudy. J Clin Oncol, 2005,23:9243-9249.
[10]Foster JH. Treatment of metastatic disease of the liver: a skeptic' s view. Semin liver Dis, 1984,4:170-179.
[11]Tsai M, Su Y, Ho M, et al. Clinicopathological features and prognosis in resectable synchronous and metachronous colorectal liver metastases. Ann Surg Oncol, 2007,14:786-794.
[12]Stangl R, Altendorf A. Factors influencing the natural history of colorectal liver metastases. Lancet, 1994,343:1405-1410.
[13]柳复生,杜国元,何劲松,等.大肠癌肝转移的疗效分析[J].临床外科杂志,1998,6(1):29.
[14]Prot T, Halkic N, Demartines N, et al. Surgical management of colorectal liver metastasis[J]. Rev Med Suisse, 2007,3(117):1638-1642.
[15]Jemal A, Siegel R. Cancer statistics. 2008.CA Cancer J Clin, 2008,58:71-96.
[16]Fong Y, Cohen AM, Fortner JG, et al. Liver resection for colorectal metastases. J Clin Oncol, Mar 1997,15(3):938-946.
[17]ElsalehH,CserniG,Iacopetta.B,.et.al..Extent.of.nodal.involvement.in.Stage.III.colorectal carcinoma: relationship to clinicopathologic variables and genetic alterations. Dis Colon Rectum, 2002,45:1218-1222.
[18]Choi HJ, Choi YY, Hong SH, et al. Incidence and prognostic implications of isolated tumor cells in lymph nodes from patients with Dukes B colorectal carcinoma. Dis Colon Rectum, 2002,45:750-755.
[19]Wichmann MW,Muller C,Hornung HM,et al. Gender differences in long-term survival of patients with colorectal cancer. Br J Surg,2001,88:1092-1098.
[20]大肠癌病理与预后关系研究协作组.国人青年人大肠癌的特点和预后:319例病理分析.中华肿瘤杂志,1986,8:146-148.
[21]Harris GJ, Senagore AJ, Lavery IC, et al. Factors affecting survival after palliative resection of colorectal carcinoma[J]. Colorectal Dis, 2002,4(1):31-35.
[22]罗吉辉,高枫,张森,等.122例结直肠癌同时性肝转移患者的临床预后分析.中国肿瘤临床,2009,36(6):308-312.
[23]Tomisaki S, Ohno S, Ichiyoshi Y, et a1. Microvessel quantification and its possible relation with liver metastasis in colorectal cancer[J]. Cancer, 1996,77(8Suppl): 1722-1728.
[24]Secco GB, Fardelli R, Gianquinto D, et a1. Factors influencing incidence and extension of metachronous liver metastases of colorectal adenocarcinoma: a multivariatean alysis[J]. Hepatogastroenterology, 1997,44:1057-1062.
[25]Mehrkhani F, Nasiri S, Donboli K, et al. Prognostic factors in survival of colorectal cancer patients after surgery[J]. Colorectal Dis, 2009,11(2):157-161.
[26]Allen PJ, Kemeny N, Jarnagin W, et al. Importance of response to neoadjuvant chemotherapy in patients undergoing resection of synchronous colorectal liver matastases[J]. J Gastrointest Surg, 2003,7(1):109-115;discussion 116-117.
[27]Scheele J, Stang R, Altendorf A, et al. Resection of colorectal liver metastases. World J Surg, 1995,19:59-71.
[28]周志伟,任镜清,万德森,等.结直肠癌肝转移患者预后的多因素分析.癌症,2006,25:1149-1152.
[29]Fong Y, Fortner J, Sun RL, et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis 0f 100l consecutive cases. Ann Surg, 1999,230:309-318.
[30]蔡光荣,邵祥麟,李勇,等.大肠癌伴肝转移的治疗及预后因素分析:附52例报告.中国普通外科杂志,2005,14 (3):197-199.
[31]颜登国,张汝一,程海玉,等.影响结直肠癌肝转移预后的因素[J/CD].中华临床医师杂志:电子版,2009,3 ( 2) :242-251.
[32]Ishizuka D, Shirai Y, Sakai Y, et al. Colorectal carcinoma liver metastases: clinical significance of preoperative measurement of serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels[J]. Int J Colorectal Dis, 2001,16(1):32-37.
[33]Arru M, Aldrighetti L, Castoldi R, et a1. Analysis of prognostic factors influencing long-term survival after hepatic resection for metastatic colorectal cancer[J]. World J Surg, 2008,32(1):93-103.
[34]Wiratkapun S, Kraemer M, Seow F, et al.High preoperative serum carcinoembryonic antigen predicts metastatic recurrence in potentially curative colonic cancer: results of a five-year study[J]. Dis Colon Rectum, 2001,44(2):231-235.
[35]Isabelle I, Frederic D, Isabelle R, et al. Usefulness of the Serum Carcinoembryonic Antigen Kinetic for Chemotherapy Monitoring in Patients With Unresectable Metastasis of Colorectal Cancer. J Clin Oncol, 2008,26:3681-3686.
[36]Navarra G, Ayav A, Weber JG, et a1. Short-and long--term results of intraoperative radiofrequency ablation of liver metastases [J]. Int J Colorectal Dis, 2005, 20(6): 521-528.
[37]Venook AP. The kemeny article reviewed. Oncology, 2006,20:477-484.
[38]Choti MA, Sitzmann JV, Tiburi MF, et al. Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg, 2002,235:759-766.
[39]Pawlik TM, Poon RT, Abdalla EK, et al. Critical appraisal of the clinical and pathologic predictors of survival after resection of large hepatocellular carcinoma. Arch Surg, 2005,140:450-457;discussion 457-458.
[40]Charnsangavej C, Clary B, Foog Y, et al. Selection of patients for resection of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol, 2006,13:1261-1268.
[41]Vauthey.JN,Zorzi.D,.Pawlik.TM,.et.al.Making.unresectable.hepatic.colorectal.metastases resectable-does it work? Semin Oncol, Dec2005,32(6 suppl 9):S118-122.
[42]Pozzo C,Basso M,Cassano A,et al. Neoadjuvant treatment of unresectable liver disease with irinotecan and 5-fluorouracil plus folinic acid in colorectal cancer patients. Ann Oncol, 2004,15:933-939.
[43]Altendorf A, Scheele J. A critical review of the major indicators of prognosis after resection of hepatic metastases from colorectal carcinoma. Surg Oncol Clin N Am, 2003,12:165-192.
[44]Pawlik TM, Schulick RD, Choti MA, et al. Expanding criteria for resectability of colorectal liver metastases. The Oncologist, 2008,13:51-64.
[45]Adam R, Avisar E, Ariche A, et a1. Five-year survival following hepatic resection after neoadjuvant therapy for nonresectable Colorectal[liver]metastases[J]. Ann Surg Oncol, 2001,8(4):347-353.
[1]殷蔚伯,谷铣之主编.肿瘤放射治疗学.第4版.北京:中国协和医科大学出版社, 2007:855.
[2] Brian M, Wolpin, Jeffrey A, et al. Adjuvant Treatment of Colorectal Cancer. Cancer J Clin, 2007,57:168-185.
[3] Shellito PC, Clark JW, Willett CG, et al. A 61-year-old man with rectal bleeding and a 2-cm mass in the rectum. N Engl J Med, 2004, 350: 2500-2509.
[4] Willett CG, Compton CC, Shellito PC, et al. Selection factors for local excision or abdominoperineal resection of early stage rectal cancer. Cancer, 1994, 73: 2716- 2720.
[5] Steele GD, Herndon JE, Bleday R, et al. Sphincter-sparing treatment for distal rectal adenocarcinoma. Ann Surg Oncol, 1999,6:433-441.
[6] Greenberg J, Bleday R. Local excision of rectal cancer oncologic results. Semin Colon Rectal Surg, 2005,16:40-46.
[7] Wirsing K, Lorenzo S, Luchtefeld M, et al. Local excision of stratified T1 rectal cancer. Am J Surg, 2006,191:410-412.
[8] Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med, 2001, 345: 638-646.
[9] Douglass HO, Moertel CG, Mayer RJ, et al. Survival after postoperative combination treatment of rectal cancer. N Engl J Med, 1986,315:1294-1295.
[10]Krook JE, Moertel CG, Gunderson LL, et al. Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med, 1991, 324:709-715.
[11]Nir W, Haim G. Israel Resection Margins in Modern Rectal Cancer. Surgery Journal of Surgical Oncology, 2008,98:611-615.
[12]Iris D, Nagtegaal, Phil Q. What Is the Role for the Circumferential Margin in the Modern Treatment of Rectal Cancer? J Clin Oncol, 2008,26:303-312.
[13]Marijnen CA, Velde CJ, Putter H, et al. Impact of short-term preoperative radiotherapy on health-related quality of life and sexual functioning in primary rectal cancer:Report of a multicenter randomized trial. J Clin Oncol, 2005,23:1847-1858.
[14]Wallner C, Lange MM, Bonsing BA, et al. Causes of fecal and urinary incontinence after total mesorectal excision for rectal cancer based on cadaveric surgery: A study from the Cooperative Clinical Investigators of the Dutch total mesorectal excision trial. J Clin Oncol, 2008,26:4466-4472.
[15]Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemora diotherapy for rectal cancer. N Engl J Med, 2004,351:1731-1740.
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[17]Meta-analysis Group in Cancer. Efficacy of intravenous continuous infusion of fluorouracil compared with bolus administration in advanced colorectal cancer. J Clin Oncol, 1998,16:301-308.
[18]Gregory D, Leonard, Baruch B, et al. Neoadjuvant Chemotherapy Before Liver Resection for Patients With Unresectable Liver Metastases From Colorectal Carcinoma. J Clin Oncol, 2005,23:2038-2048.
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[22]De A, Figer A, Seymour M, et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol, 2000,18:2938-2947.
[23]Jim C, Stephen C. Randomized Phase III Study of Capecitabine Plus Oxaliplatin Compared With Fluorouracil/Folinic Acid Plus Oxaliplatin As First-Line Therapy for Metastatic Colorectal Cancer. J Clin Oncol, 2008,26:2006-2012.
[2]殷蔚伯,谷铣之主编.肿瘤放射治疗学,第4版.北京:中国协和医科大学出版社出版,2007:855.
[3] Nelson H, Petrelli N, Carlin A, et al. Guidelines 2000 for colon and rectal cancer surgery. J Natl Cancer Inst, 2001,93:583-596.
[4] Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med, 2001,345:638-646.
[5] Van CE, Nordlinger B, Adam R, et al. Towards a pan-European consensus on the treatment of patients with colorectal liver metastases. Eur J Cancer, 2006, 42: 2212- 2221.
[6] Yoo PS, Lopez RI, Longo WE, et al. Liver resection for metastatic colorectal cancer in the age of neoadjuvant chemotherapy and bevacizumab. Clin Colorectal Cancer, 2006,6:202-207.
[7] Kemeny N. Management of liver metastases from colorectal cancer. Oncology (Williston Park), 2006,20:1161-1176,1179;discussion 1179-1180,1185-1166.
[8] Muratore A, Zorzi D, Bouzari H, et al. Asymptomatic colorectal cancer with re-resectable liver metastases: immediate colorectal resection or up-front systemic chemotherapy? Ann Surg Oncol, 2007,14:766-770.
[9] Alberts SR, Horvath WL, Sternfeld WC, et al. Oxaliplatin, fluorouracil, and leucovorin for patients with unresectable liver-only metastases from colorectal cancer: a North Central Cancer Treatment Group phaseⅡstudy. J Clin Oncol, 2005,23:9243-9249.
[10]Foster JH. Treatment of metastatic disease of the liver: a skeptic' s view. Semin liver Dis, 1984,4:170-179.
[11]Tsai M, Su Y, Ho M, et al. Clinicopathological features and prognosis in resectable synchronous and metachronous colorectal liver metastases. Ann Surg Oncol, 2007,14:786-794.
[12]Stangl R, Altendorf A. Factors influencing the natural history of colorectal liver metastases. Lancet, 1994,343:1405-1410.
[13]柳复生,杜国元,何劲松,等.大肠癌肝转移的疗效分析[J].临床外科杂志,1998,6(1):29.
[14]Prot T, Halkic N, Demartines N, et al. Surgical management of colorectal liver metastasis[J]. Rev Med Suisse, 2007,3(117):1638-1642.
[15]Jemal A, Siegel R. Cancer statistics. 2008.CA Cancer J Clin, 2008,58:71-96.
[16]Fong Y, Cohen AM, Fortner JG, et al. Liver resection for colorectal metastases. J Clin Oncol, Mar 1997,15(3):938-946.
[17]ElsalehH,CserniG,Iacopetta.B,.et.al..Extent.of.nodal.involvement.in.Stage.III.colorectal carcinoma: relationship to clinicopathologic variables and genetic alterations. Dis Colon Rectum, 2002,45:1218-1222.
[18]Choi HJ, Choi YY, Hong SH, et al. Incidence and prognostic implications of isolated tumor cells in lymph nodes from patients with Dukes B colorectal carcinoma. Dis Colon Rectum, 2002,45:750-755.
[19]Wichmann MW,Muller C,Hornung HM,et al. Gender differences in long-term survival of patients with colorectal cancer. Br J Surg,2001,88:1092-1098.
[20]大肠癌病理与预后关系研究协作组.国人青年人大肠癌的特点和预后:319例病理分析.中华肿瘤杂志,1986,8:146-148.
[21]Harris GJ, Senagore AJ, Lavery IC, et al. Factors affecting survival after palliative resection of colorectal carcinoma[J]. Colorectal Dis, 2002,4(1):31-35.
[22]罗吉辉,高枫,张森,等.122例结直肠癌同时性肝转移患者的临床预后分析.中国肿瘤临床,2009,36(6):308-312.
[23]Tomisaki S, Ohno S, Ichiyoshi Y, et a1. Microvessel quantification and its possible relation with liver metastasis in colorectal cancer[J]. Cancer, 1996,77(8Suppl): 1722-1728.
[24]Secco GB, Fardelli R, Gianquinto D, et a1. Factors influencing incidence and extension of metachronous liver metastases of colorectal adenocarcinoma: a multivariatean alysis[J]. Hepatogastroenterology, 1997,44:1057-1062.
[25]Mehrkhani F, Nasiri S, Donboli K, et al. Prognostic factors in survival of colorectal cancer patients after surgery[J]. Colorectal Dis, 2009,11(2):157-161.
[26]Allen PJ, Kemeny N, Jarnagin W, et al. Importance of response to neoadjuvant chemotherapy in patients undergoing resection of synchronous colorectal liver matastases[J]. J Gastrointest Surg, 2003,7(1):109-115;discussion 116-117.
[27]Scheele J, Stang R, Altendorf A, et al. Resection of colorectal liver metastases. World J Surg, 1995,19:59-71.
[28]周志伟,任镜清,万德森,等.结直肠癌肝转移患者预后的多因素分析.癌症,2006,25:1149-1152.
[29]Fong Y, Fortner J, Sun RL, et al. Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis 0f 100l consecutive cases. Ann Surg, 1999,230:309-318.
[30]蔡光荣,邵祥麟,李勇,等.大肠癌伴肝转移的治疗及预后因素分析:附52例报告.中国普通外科杂志,2005,14 (3):197-199.
[31]颜登国,张汝一,程海玉,等.影响结直肠癌肝转移预后的因素[J/CD].中华临床医师杂志:电子版,2009,3 ( 2) :242-251.
[32]Ishizuka D, Shirai Y, Sakai Y, et al. Colorectal carcinoma liver metastases: clinical significance of preoperative measurement of serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels[J]. Int J Colorectal Dis, 2001,16(1):32-37.
[33]Arru M, Aldrighetti L, Castoldi R, et a1. Analysis of prognostic factors influencing long-term survival after hepatic resection for metastatic colorectal cancer[J]. World J Surg, 2008,32(1):93-103.
[34]Wiratkapun S, Kraemer M, Seow F, et al.High preoperative serum carcinoembryonic antigen predicts metastatic recurrence in potentially curative colonic cancer: results of a five-year study[J]. Dis Colon Rectum, 2001,44(2):231-235.
[35]Isabelle I, Frederic D, Isabelle R, et al. Usefulness of the Serum Carcinoembryonic Antigen Kinetic for Chemotherapy Monitoring in Patients With Unresectable Metastasis of Colorectal Cancer. J Clin Oncol, 2008,26:3681-3686.
[36]Navarra G, Ayav A, Weber JG, et a1. Short-and long--term results of intraoperative radiofrequency ablation of liver metastases [J]. Int J Colorectal Dis, 2005, 20(6): 521-528.
[37]Venook AP. The kemeny article reviewed. Oncology, 2006,20:477-484.
[38]Choti MA, Sitzmann JV, Tiburi MF, et al. Trends in long-term survival following liver resection for hepatic colorectal metastases. Ann Surg, 2002,235:759-766.
[39]Pawlik TM, Poon RT, Abdalla EK, et al. Critical appraisal of the clinical and pathologic predictors of survival after resection of large hepatocellular carcinoma. Arch Surg, 2005,140:450-457;discussion 457-458.
[40]Charnsangavej C, Clary B, Foog Y, et al. Selection of patients for resection of hepatic colorectal metastases: expert consensus statement. Ann Surg Oncol, 2006,13:1261-1268.
[41]Vauthey.JN,Zorzi.D,.Pawlik.TM,.et.al.Making.unresectable.hepatic.colorectal.metastases resectable-does it work? Semin Oncol, Dec2005,32(6 suppl 9):S118-122.
[42]Pozzo C,Basso M,Cassano A,et al. Neoadjuvant treatment of unresectable liver disease with irinotecan and 5-fluorouracil plus folinic acid in colorectal cancer patients. Ann Oncol, 2004,15:933-939.
[43]Altendorf A, Scheele J. A critical review of the major indicators of prognosis after resection of hepatic metastases from colorectal carcinoma. Surg Oncol Clin N Am, 2003,12:165-192.
[44]Pawlik TM, Schulick RD, Choti MA, et al. Expanding criteria for resectability of colorectal liver metastases. The Oncologist, 2008,13:51-64.
[45]Adam R, Avisar E, Ariche A, et a1. Five-year survival following hepatic resection after neoadjuvant therapy for nonresectable Colorectal[liver]metastases[J]. Ann Surg Oncol, 2001,8(4):347-353.
[1]殷蔚伯,谷铣之主编.肿瘤放射治疗学.第4版.北京:中国协和医科大学出版社, 2007:855.
[2] Brian M, Wolpin, Jeffrey A, et al. Adjuvant Treatment of Colorectal Cancer. Cancer J Clin, 2007,57:168-185.
[3] Shellito PC, Clark JW, Willett CG, et al. A 61-year-old man with rectal bleeding and a 2-cm mass in the rectum. N Engl J Med, 2004, 350: 2500-2509.
[4] Willett CG, Compton CC, Shellito PC, et al. Selection factors for local excision or abdominoperineal resection of early stage rectal cancer. Cancer, 1994, 73: 2716- 2720.
[5] Steele GD, Herndon JE, Bleday R, et al. Sphincter-sparing treatment for distal rectal adenocarcinoma. Ann Surg Oncol, 1999,6:433-441.
[6] Greenberg J, Bleday R. Local excision of rectal cancer oncologic results. Semin Colon Rectal Surg, 2005,16:40-46.
[7] Wirsing K, Lorenzo S, Luchtefeld M, et al. Local excision of stratified T1 rectal cancer. Am J Surg, 2006,191:410-412.
[8] Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med, 2001, 345: 638-646.
[9] Douglass HO, Moertel CG, Mayer RJ, et al. Survival after postoperative combination treatment of rectal cancer. N Engl J Med, 1986,315:1294-1295.
[10]Krook JE, Moertel CG, Gunderson LL, et al. Effective surgical adjuvant therapy for high-risk rectal carcinoma. N Engl J Med, 1991, 324:709-715.
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