Bilchik A J, Wood T F, Chawla S P, Rose D M, Chung M H, Stern S S, Foshag L J, Ramming K P
John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA, USA.
Clin Colorectal Cancer. 2001 May;1(1):36-42. doi: 10.3816/CCC.2001.n.003.
Most colorectal cancers metastatic to the liver are resistant to chemotherapy and are not amenable to surgical resection. This study evaluated our 6-year experience (July 1992-July 1998) in treating patients with unresectable hepatic colorectal metastases refractory to systemic 5-fluorouracil (5-FU). One hundred fifty-three patients underwent cryosurgical ablation (CSA) of 5-FU-resistant hepatic metastases. The patients then received either hepatic arterial floxuridine (FUDR), systemic CPT-11, or no postoperative adjuvant chemotherapy. Number, size, and location of hepatic metastases, carcinoembryonic antigen (CEA) levels, and type of postoperative treatment were analyzed. One to 15 lesions were frozen (median number, 3; median size, 6 cm), for a total of 73 synchronous and 80 metachronous lesions. Overall median survival was 28.4 months from the date of diagnosis of liver metastases and 16.1 months from the time of CSA. After cryosurgery alone, median survival was 13 months, which was significantly shorter than the post-CSA survival of 23.6 months with adjuvant CPT-11 and 21.2 months with hepatic FUDR (P = 0.007). Predictors of survival included preoperative CEA, postoperative reduction in CEA, and adjuvant chemotherapy (P < 0.05). Neither size, number of lesions, nor tumor location impacted survival. At a median follow-up of 13 months, 67% of patients have recurred (35% hepatic, 16% extrahepatic, and 49% both). Twenty percent of the recurrences were in the lobe of the CSA site. The 25 patients who underwent a second CSA had a median survival of 28.4 months from CSA and 40 months from the date of diagnosis of liver metastases. These data indicate that CSA offers an effective alternative for unresectable patients resistant to 5-FU. Systemic CPT-11 or regional FUDR may further prolong survival after CSA.
大多数转移性至肝脏的结直肠癌对化疗耐药，且无法进行手术切除。本研究评估了我们在1992年7月至1998年7月这6年间治疗对全身应用5-氟尿嘧啶（5-FU）耐药的不可切除肝结直肠癌转移患者的经验。153例患者接受了对5-FU耐药的肝转移灶的冷冻手术消融（CSA）。这些患者随后接受了肝动脉氟尿苷（FUDR）、全身应用伊立替康（CPT-11）或未接受术后辅助化疗。分析了肝转移灶的数量、大小和位置、癌胚抗原（CEA）水平以及术后治疗类型。共冷冻1至15个病灶（中位数为3个；中位数大小为6 cm），其中同步病灶73个，异时病灶80个。从肝转移诊断日期起的总体中位生存期为28.4个月，从CSA时间起为16.1个月。单纯冷冻手术后，中位生存期为13个月，显著短于接受辅助CPT-11治疗后CSA的生存期（23.6个月）以及接受肝FUDR治疗后CSA的生存期（21.2个月）（P = 0.007）。生存的预测因素包括术前CEA、术后CEA降低以及辅助化疗（P < 0.05）。病灶大小、数量及肿瘤位置均不影响生存。中位随访13个月时，67%的患者出现复发（35%为肝内复发，16%为肝外复发，49%为肝内肝外均复发）。20%的复发发生在CSA部位所在的肝叶。接受第二次CSA的25例患者从CSA起的中位生存期为28.4个月，从肝转移诊断日期起为40个月。这些数据表明，CSA为对5-FU耐药的不可切除患者提供了一种有效的替代治疗方法。全身应用CPT-11或局部应用FUDR可能会进一步延长CSA后的生存期。
