Adam René, Wicherts Dennis A, de Haas Robbert J, Aloia Thomas, Lévi Francis, Paule Bernard, Guettier Catherine, Kunstlinger Francis, Delvart Valérie, Azoulay Daniel, Castaing Denis
AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, 12 Avenue Paul Vaillant Couturier, F-94804 Villejuif, France.
J Clin Oncol. 2008 Apr 1;26(10):1635-41. doi: 10.1200/JCO.2007.13.7471.
Complete clinical response (CCR) of colorectal liver metastases (CLM) following chemotherapy is of limited predictive value for complete pathologic response (CPR) and cure of the disease. The objective of this study was to determine predictive factors of CPR as well as its impact on survival.
From January 1985 to July 2006, 767 consecutive patients with CLM underwent liver resection after systemic chemotherapy. Patients with CPR were compared with patients without CPR.
Twenty-nine of 767 (4%) patients had CPR, and none of these 29 patients had CCR. Patients with CPR (mean age, 54 years) had a mean number of 3.3 metastases at diagnosis (mean size, 29.3 mm). Objective response and stable disease were observed in 79% and 21% of cases, respectively. Postoperative mortality rate was 0%. After a median follow-up of 52.2 months (range, 1.1 to 193.0 months), overall 5-year survival was 76% for patients with CPR compared with 45% for patients without CPR (P = .004). Independent predictive factors for CPR were: age <or= 60 years, size of metastases <or= 3 cm at diagnosis, carcinoembryonic antigen (CEA) level at diagnosis <or= 30 ng/mL, and objective response following chemotherapy. The probability of CPR ranged from 0.2% when all factors were absent to 30.9% when all were present.
CPR was observed in 4% of patients with CLM treated with preoperative chemotherapy. However, CPR may occur in almost one-third of objective responders age <or= 60 years with metastases <or= 3 cm and low CEA values. CPR is associated with uncommon high survival rates.
化疗后结直肠癌肝转移（CLM）的完全临床缓解（CCR）对疾病的完全病理缓解（CPR）及治愈的预测价值有限。本研究的目的是确定CPR的预测因素及其对生存的影响。
1985年1月至2006年7月，767例连续性CLM患者在全身化疗后接受肝切除术。将有CPR的患者与无CPR的患者进行比较。
767例患者中有29例（4%）出现CPR，这29例患者均无CCR。有CPR的患者（平均年龄54岁）诊断时转移灶平均数量为3.3个（平均大小29.3mm）。分别有79%和21%的病例观察到客观缓解和疾病稳定。术后死亡率为0%。中位随访52.2个月（范围1.1至193.0个月）后，有CPR的患者5年总生存率为76%，无CPR的患者为45%（P = 0.004）。CPR的独立预测因素为：年龄≤60岁、诊断时转移灶大小≤3cm、诊断时癌胚抗原（CEA）水平≤30ng/mL以及化疗后的客观缓解。当所有因素均不存在时，CPR的概率为0.2%；当所有因素均存在时，CPR的概率为30.9%。
术前化疗的CLM患者中有4%观察到CPR。然而，年龄≤60岁、转移灶≤3cm且CEA值低的客观缓解者中近三分之一可能出现CPR。CPR与罕见的高生存率相关。
