Akira Hanai

Multivariate analysis of the prognostic factors of patients with unresectable synchronous liver metastases from colorectal cancer

PURPOSE: It frequently is observed that widely varying prognoses are given for patients with the same extent of liver metastases from colorectal cancer, even though the same treatment is performed on these patients. One of the reasons for this variance is that prognostic factors for these patients have not been defined. This study was designed to elucidate which clinicopathologic factors were the most important in the prognosis of 73 patients with unresectable synchronous liver metastasis from colorectal cancer. METHODS: Univariate and multivariate analysis of 11 clinicopathologic factors were performed using the Cox proportional hazard model. Survival curves were generated using the Kaplan-Meier method. RESULTS: Extent of liver metastases was the most significant variable in this survival analysis, although the extent of lymph node metastases of the primary lesion also was significant. However, the method of treatment was not a significant determinant in the survival for patients with unresectable liver metastases. Median survival of patients with H1, H2, and H3 was 13, 12, and 6 months, respectively, and there was a significant difference between survival curves for patients with H1 and patients with H3. Median survival of patients with n0, n1 and n2 was 13, 7, and 7 months respectively, and there was a significant difference between survival curves for patients with n0 and patients with n2. Median survival of 6 patients with H1 and n0 and of 17 patients with H3 and n2 was 28 and 4 months, respectively. There was a significant difference in survival curves between these two groups. CONCLUSION: Longevity of patients with unresectable synchronous liver metastases from colorectal cancer is affected adversely by the presence of nodal metastases and extent of liver metastases. This should be considered in the planning treatment.

Giant Extrahepatic Hepatocellular Carcinoma. Report of Three Cases.

肝外発育型肝癌は比較的まれな疾患であり, その発生機序についてはいまだ明らかでない.また診断, 治療についても通常の肝癌と趣を異にする.われわれは3例の肝外発育型肝癌を経験した.症例1は38歳女で有茎型で, 肝実質は正常であった.肝部分切除後4年9か月健存している.症例2は39歳女で有茎型で, 慢性肝炎を併存していた.肝部分切除後2年8か月健存している.症例3は61歳男で肝外突出型で肝内転移があり, 肝硬変を併存していた.肝外側区域切除後7か月で死亡した.診断には超音波検査, computed tomography検査, 腫瘍マーカーが参考になり, 血管造影による栄養血管の確認が最も良いと思われた.治療は有茎型は小範囲の肝切除で予後は良好である.一方, 肝外突出型は通常の肝癌と同様必ずしも予後は良好とはいえない.