Ng Jennica K S, Urbanski Stefan J, Mangat Naurang, McKay Andrew, Sutherland Francis R, Dixon Elijah, Dowden Scot, Ernst Scott, Bathe Oliver F
Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
Cancer. 2008 Jan 15;112(2):362-71. doi: 10.1002/cncr.23184.
Recently, there has been considerable interest in neoadjuvant chemotherapy for colorectal liver metastases. However, there is little information that defines how much liver should be removed after a favorable response.
Liver metastases from 2 groups of patients were analyzed: 25 metastases were evaluated from a group that did not receive chemotherapy and 26 lesions were studied from patients who had received systemic chemotherapy before resection. All patients except for 1 had 5-fluorouracil (5-FU), leucovorin (LV), and irinotecan (CPT-11); 1 had 5-FU and LV alone. The average duration of chemotherapy was 2.9+/-0.7 months. Separate assessments of the histopathologic features of the central and peripheral portions of each tumor were made. The pathologist was blinded to all clinical information.
All of the untreated metastases had well-circumscribed borders. Irregular borders were seen in 6 of the postchemotherapy lesions (26%), which was particularly prominent in lesions that had significantly contracted. After chemotherapy, discrete islands of viable tumor cells outside of the main tumor mass were seen in 4 patients, but all were close to the peripheral margin of the tumor mass. Viable tumor cells were more frequent in the periphery of metastases, regardless of chemotherapy exposure. Central necrosis was prominent in untreated metastases, but disappeared after chemotherapy. In lesions treated with chemotherapy, central fibrosis was greater compared with untreated lesions.
After a partial response to chemotherapy, liver metastases shrank in a generally concentric fashion. These findings support the practice of removing less liver after downsizing with chemotherapy.
最近，结直肠癌肝转移的新辅助化疗引起了广泛关注。然而，关于在化疗取得良好疗效后应切除多少肝脏的相关信息却很少。
分析了两组患者的肝转移情况：一组未接受化疗的25处转移灶，以及一组术前接受全身化疗的26处病灶。除1名患者外，所有患者均接受了氟尿嘧啶（5-FU）、亚叶酸钙（LV）和伊立替康（CPT-11）治疗；1名患者仅接受了5-FU和LV治疗。化疗的平均持续时间为2.9±0.7个月。对每个肿瘤的中央和周边部分的组织病理学特征进行了单独评估。病理学家对所有临床信息均不知情。
所有未经治疗的转移灶边界均清晰。化疗后病灶中有6处（26%）出现边界不规则，在明显缩小的病灶中尤为突出。化疗后，4名患者的主肿瘤块外可见离散的存活肿瘤细胞岛，但均靠近肿瘤块的周边边缘。无论是否接受化疗，存活肿瘤细胞在转移灶周边更为常见。未经治疗的转移灶中央坏死明显，但化疗后消失。与未经治疗的病灶相比，接受化疗的病灶中央纤维化更严重。
化疗部分缓解后，肝转移灶通常呈同心方式缩小。这些发现支持在化疗缩小肿瘤体积后减少肝脏切除量的做法。
