Reddy Srinevas K, Barbas Andrew S, Marroquin Carlos E, Morse Michael A, Kuo Paul C, Clary Bryan M
Department of Surgery, Duke University Medical Center, Durham, NC 27713, USA.
J Am Coll Surg. 2007 Mar;204(3):372-82. doi: 10.1016/j.jamcollsurg.2006.12.019.
Although established for metastatic colorectal (CR) and neuroendocrine (NE) malignancies, the role of partial hepatectomy in management of metastases from other primaries (NCRNE) is not well-defined.
The objective of this retrospective study is to compare outcomes after partial hepatectomy for NCRNE, NE, and CR metastases and to identify factors associated with longterm survival for patients with NCRNE diseases. Tumor characteristics, treatments, and outcomes of 360 consecutive patients undergoing resection of NCRNE (n = 82), CR (n = 245), and NE (n = 33) hepatic metastases from 1995 to 2005 were analyzed. NCRNE tumors included breast (n = 20), sarcomas (n = 19), genitourinary (n = 18), melanoma (n = 11), and other (n = 14) cancers. The start date for follow-up and survival analyses was the date of partial hepatectomy.
For patients with NCRNE, CR, and NE tumors, there were no marked differences in postoperative mortality (4%, 4%, and 9%) or complication (30%, 42%, and 42%) rates. Median overall survival was longest for NE patients (not yet reached) versus NCRNE and CR (both 44 months) patients (p < 0.05, log-rank test). NCRNE patients had shorter disease-free survival than CR counterparts (13 versus 16 months), p < 0.05 (log-rank test). After median followup of 59 months for NCRNE patients, actuarial 5-year overall and disease-free survival was 37% and 16%, respectively, with 15 5-year survivors. Multivariable analysis suggests that interval from discovery of liver metastases to resection > 6 months (p = 0.08) and administration of chemoradiotherapy after resection (p = 0.06) might be associated with improved overall survival.
In selected patients, resection of NCRNE liver metastases can be done safely with survival similar to CR metastases. Delay of liver resection for at least 6 months and treatment with chemoradiotherapy after resection might be associated with improved longterm survival after partial hepatectomy.
尽管部分肝切除术在转移性结直肠癌（CR）和神经内分泌（NE）恶性肿瘤的治疗中已确立了地位，但其在其他原发肿瘤转移灶（NCRNE）治疗中的作用尚不明确。
这项回顾性研究的目的是比较NCRNE、NE和CR转移灶行部分肝切除术后的结局，并确定与NCRNE疾病患者长期生存相关的因素。分析了1995年至2005年连续360例行NCRNE（n = 82）、CR（n = 245）和NE（n = 33）肝转移灶切除患者的肿瘤特征、治疗方法和结局。NCRNE肿瘤包括乳腺癌（n = 20）、肉瘤（n = 19）、泌尿生殖系统癌（n = 18）、黑色素瘤（n = 11）和其他癌症（n = 14）。随访和生存分析的起始日期为部分肝切除日期。
对于NCRNE、CR和NE肿瘤患者，术后死亡率（4%、4%和9%）或并发症发生率（30%、42%和42%）无明显差异。NE患者的中位总生存期最长（未达到），而NCRNE和CR患者（均为44个月）的中位总生存期较短（p < 0.05，对数秩检验）。NCRNE患者的无病生存期短于CR患者（13个月对16个月），p < 0.05（对数秩检验）。NCRNE患者中位随访59个月后，5年总生存率和无病生存率分别为37%和16%，有15例5年生存者。多变量分析表明，从发现肝转移到切除的间隔时间> 6个月（p = 0.08）和切除后进行放化疗（p = 0.06）可能与总生存期改善有关。
在选定的患者中，NCRNE肝转移灶的切除可以安全进行，生存率与CR转移灶相似。肝切除延迟至少6个月以及切除后进行放化疗可能与部分肝切除术后长期生存改善有关。
