Kesmodel Susan B, Ellis Lee M, Lin E, Chang George J, Abdalla Eddie K, Kopetz Scott, Vauthey Jean-Nicolas, Rodriguez-Bigas Miguel A, Curley Steven A, Feig Barry W
Department of Surgical Oncology, Cancer Biology, Biostatistics, and Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
J Clin Oncol. 2008 Nov 10;26(32):5254-60. doi: 10.1200/JCO.2008.17.7857. Epub 2008 Oct 14.
Although bevacizumab (BV) increases survival rates when used with chemotherapy (CTX) in patients who have metastatic colorectal cancer (CRC), an increase in wound complications has been observed in patients who undergo surgery while receiving BV. We therefore evaluated whether neoadjuvant BV is associated with an increase in postoperative complications in patients undergoing surgery for CRC liver metastases.
Two subgroups of patients who received neoadjuvant CTX + BV (n = 81) or CTX alone (n = 44) were identified from a database of patients who underwent surgery for CRC liver metastases. Univariate and multivariate logistic regression models were used to evaluate the association of patient and tumor characteristics, neoadjuvant therapy, and operative factors with postoperative complications.
Postoperative complications developed in 40 patients (49%) who received CTX + BV and 19 patients (43%) who received CTX. The median time from BV discontinuation to surgery was 58 days (range, 31 to 117 days). No significant associations were identified between BV use and timing of BV discontinuation and postoperative complications. On multivariate analysis, lower serum albumin and concomitant surgical procedures were associated with an increased risk of developing any complication (P = .035 and .023, respectively), and lower serum albumin was associated with hepatobiliary complications (P = .016).
Neither the use of BV nor timing of BV administration was associated with an increase in complication rates. These data suggest that the combination of BV with neoadjuvant CTX in patients who have CRC liver metastases does not increase surgical complications. To determine the optimal timing of surgery in patients receiving neoadjuvant BV, confirmatory prospective studies are required.
尽管贝伐单抗（BV）与化疗（CTX）联合用于转移性结直肠癌（CRC）患者时可提高生存率，但在接受BV治疗期间接受手术的患者中，伤口并发症有所增加。因此，我们评估了新辅助BV是否与CRC肝转移患者手术后并发症的增加有关。
从接受CRC肝转移手术的患者数据库中确定了接受新辅助CTX + BV（n = 81）或仅接受CTX（n = 44）的两个患者亚组。使用单因素和多因素逻辑回归模型来评估患者和肿瘤特征、新辅助治疗以及手术因素与术后并发症之间的关联。
接受CTX + BV的40例患者（49%）和接受CTX的19例患者（43%）出现了术后并发症。从停用BV到手术的中位时间为58天（范围为31至117天）。未发现使用BV、停用BV的时间与术后并发症之间存在显著关联。多因素分析显示，血清白蛋白水平较低和同时进行手术与发生任何并发症的风险增加相关（分别为P = 0.035和0.023），血清白蛋白水平较低与肝胆并发症相关（P = 0.016）。
使用BV或BV给药时间均与并发症发生率增加无关。这些数据表明，BV与新辅助CTX联合用于CRC肝转移患者不会增加手术并发症。为了确定接受新辅助BV治疗患者的最佳手术时机，需要进行验证性前瞻性研究。
