Reddy Srinevas K, Morse Michael A, Hurwitz Herbert I, Bendell Johanna C, Gan Tong J, Hill Steven E, Clary Bryan M
Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
J Am Coll Surg. 2008 Jan;206(1):96-106. doi: 10.1016/j.jamcollsurg.2007.06.290. Epub 2007 Sep 17.
Although commonly used in combination with irinotecan or oxaliplatin (iri/oxal) for treatment of colorectal liver metastases before extirpation, the effects of preoperative bevacizumab on surgical outcomes are not established. The objective of this retrospective study was to determine if addition of bevacizumab to iri/oxal preoperative chemotherapy increases morbidity after hepatic resection.
We compared demographics, clinicopathologic data, treatments, and postoperative outcomes between patients given preoperative iri/oxal with and without bevacizumab and patients who underwent hepatic resection within and after 8 weeks from the last dose of bevacizumab.
From 1996 to 2006, 96 patients were treated with preoperative iri/oxal; 39 (40.6%) received concurrent bevacizumab. Preoperative bevacizumab treatment was associated with less blood loss (median 425 mL versus 600 mL, p=0.01) and lower RBC transfusion rates (43.9% versus 23.1%, p=0.06) after partial hepatectomy on univariable analysis. Only age>or=70 years (hazard ratio=8.52, 95% CI [2.00 to 36.45]) and concurrent extrahepatic procedures (hazard ratio=4.12, 95% CI [1.49 to 11.39]) independently predicted RBC transfusion and overall complications, respectively. There were no differences in overall (43.6% versus 38.6%), severe (28.2% versus 24.6%), hepatic (17.9% versus 26.3%), wound (10.3% versus 7%), or thromboembolic or bleeding (2.6% versus 5.3%) complications (all p > 0.05). For patients treated with iri/oxal and bevacizumab, overall complications were more common when resection was performed within 8 weeks after the last bevacizumab dose (62.5% versus 30.4%), but this difference was not statistically significant (p=0.06).
If discontinued at least 8 weeks before hepatic resection, addition of bevacizumab to preoperative iri/oxal does not increase morbidity after hepatic resection.
虽然贝伐单抗在肝切除术前常与伊立替康或奥沙利铂（iri/oxal）联合用于治疗结直肠癌肝转移，但术前使用贝伐单抗对手术结果的影响尚未明确。这项回顾性研究的目的是确定在iri/oxal术前化疗中加入贝伐单抗是否会增加肝切除术后的发病率。
我们比较了术前接受iri/oxal联合或不联合贝伐单抗治疗的患者，以及在最后一剂贝伐单抗给药后8周内及之后接受肝切除的患者的人口统计学、临床病理数据、治疗方法和术后结果。
1996年至2006年，96例患者接受了术前iri/oxal治疗；39例（40.6%）同时接受了贝伐单抗治疗。单因素分析显示，术前使用贝伐单抗治疗与部分肝切除术后失血量较少（中位数425 mL对600 mL，p=0.01）和红细胞输注率较低（43.9%对23.1%，p=0.06）相关。仅年龄≥70岁（风险比=8.52，95%可信区间[2.00至36.45]）和同时进行肝外手术（风险比=4.12，95%可信区间[1.49至11.39]）分别独立预测红细胞输注和总体并发症。总体（43.6%对38.6%）、严重（28.2%对24.6%）、肝脏（17.9%对26.3%）、伤口（10.3%对7%）或血栓栓塞或出血（2.6%对5.3%）并发症方面无差异（所有p>0.05）。对于接受iri/oxal和贝伐单抗治疗的患者，在最后一剂贝伐单抗给药后8周内进行切除时，总体并发症更常见（62.5%对30.4%），但这种差异无统计学意义（p=0.06）。
如果在肝切除术前至少停药8周，在术前iri/oxal中加入贝伐单抗不会增加肝切除术后的发病率。
