摘要：Objective To explore the prognostic factors of patients with unresectable liver metastasis colorectal cancer after failed conversion chemotherapy. Methods A retrospective, case-controlled study was performed. Study subjects were 105 patients who were diagnosed with synchronous liver metastasis colorectal cancer after failed chemotherapy (metastasis evaluated as unresectable after the conversion chemotherapy) at Xinhua Hospital, Shanghai Jiaotong University from January 2012 to December 2015. Overall survival(OS) was retrospectively analyzed using Kaplan-Meier method. Log-rank test was used to compare survival among groups. Univariate and multivariate analysis was conducted for prognosis using Cox regression model. Results Of 105 cases,70 were male and 35 were female with median age of 60 years old. Twenty-one patients had right colon cancer, 41 had left colon cancer, 42 had rectal cancer and 1 had synchronous cancers(sigmoid colon and rectum). One hundred and two (97.1%) patients were cT3-4 and 90 patients were cN+(imaging diagnosis). Eighty-nine (84.8%) patients were loaded with 2 or more liver metastases with the median maximum diameter of 48.3 mm. The patients were followed up for 3 to 43 months from the day of diagnosis. The median OS was 11 months (interquartile range, 8-18). The median OS of patients with cN0, cN1 and cN2 stage was 17, 13 and 10 months, respectively (P＝0.026). The median OS of patients with single lesion, 2-3 lesions, 4-10 lesions and more than 10 lesions was 15, 15, 17 and 9 months, respectively (P＝0.002). OS of patients with maximum diameter of liver metastatic lesion ≤ 50 mm, 51-100 mm and ＞100 mm was 15, 10 and 8 months, respectively (P＝0.003). The median OS of patients with chemotherapy response of partial response (PR), stable disease (SD) and progressive disease (PD) was 17, 14 and 8 months, respectively (P ＜0.001). OS was 17 months in patients receiving second line chemotherapy and was 10 months in those without second line chemotherapy (P＜0.001). OS in patients undergoing primary tumor resection was 13 month and in those without primary tumor resection was 9 months; the difference was not significant (P＝0.060). Multivariate analysis showed that cN2 (HR＝2.115, 95%CI:1.089-4.109, P＝0.027), the maximum diameter of liver metastatic lesion more than 100 mm (HR＝3.112, 95%CI:1.455-6.657, P＝0.003), chemotherapy response of PD (HR＝4.435, 95%CI:2.506-7.533,P＜0.001) and without second line chemotherapy (HR＝4.432,95%CI:2.186-8.986, P＝0.010) were independent prognostic factors. Conclusions For patients with unresectable liver metastasis from colorectal cancer after failed conversion chemotherapy, prognostic factors include cN2, the maximum diameter of liver metastatic lesion, chemotherapy response and second line chemotherapy. Whether the resection of primary tumor can prolong OS further study.%目的 探讨转化治疗失败的结直肠癌肝转移患者的预后影响因素.方法 本研究为回顾性病例对照研究,研究对象为2012—2015年间上海交通大学医学院附属新华医院收治的105例转化治疗失败(经转化治疗后肝转移灶仍评估为不可切除)的同时性结直肠癌肝转移患者.采用Kaplan-Meier方法计算总生存期(OS),Log-rank检验进行组间生存比较.采用Cox回归模型行单因素及多因素预后分析.结果 105例入组患者中位年龄60岁,男性70例,女性35例.肿瘤位于右半结肠21例,左半结肠41例,直肠42例,另有1例为同时性多发肿瘤(位于乙状结肠和直肠).肿瘤临床分期cT3~4者102例(97.1%),90例(85.7%)影像诊断淋巴结转移(cN+). 89例(84.8%)患者有2个及以上肝转移灶,肝转移灶最大直径中位数为48.3 mm.全组患者术后随访3~43月(中位数11月),中位OS为11月(四分位间距:8~18月). cN0、cN1和cN2患者中位OS分别为17月、13月和10月(P＝0.026).肝转移灶数目1个、2~3个、4~10个和＞10个者中位OS分别为15月、15月、17月和9月(P＝0.002).肝转移灶最大径≤50 mm、51~100 mm 和＞100 mm者中位OS分别为15月、10月和8月(P＝0.003).化疗反应为部分缓解、疾病稳定和疾病进展者中位OS分别为17月、14月和8月(P＜0.001).接受和未接受二线化疗者中位OS分别为17和10月(P＜0.001).原发灶切除和未切除者中位OS分别为13月和9月,但差异未达到统计学意义(P＝0.060).多因素预后分析结果显示,cN2分期(HR＝2.115,95% CI:1.089~4.109,P＝0.027)、肝脏转移灶最大直径 ＞100 mm (HR＝3.112,95%CI:1.455~6.657,P＝0.003)、化疗反应评估为疾病进展(HR＝4.345,95%CI:2.506~7.533, P＜0.001)以及未进行二线化疗(HR＝4.432,95%CI:2.186~8.986,P＝0.010)是转化治疗失败的结直肠癌肝转移患者的独立预后因素,但淋巴结转移和是否切除原发灶对患者总生存期无显著影响(均P＞0.05).结论 对于转化治疗失败的结直肠癌肝转移患者,其预后影响因素包括cN2分期、肝转移灶最大直径、化疗反应、是否行二线化疗4项因素.而原发灶切除能否为转化治疗失败的患者带来生存获益,仍需要进一步探讨.