Blazer Dan G, Kishi Yoji, Maru Dipen M, Kopetz Scott, Chun Yun Shin, Overman Michael J, Fogelman David, Eng Cathy, Chang David Z, Wang Huamin, Zorzi Daria, Ribero Dario, Ellis Lee M, Glover Katrina Y, Wolff Robert A, Curley Steven A, Abdalla Eddie K, Vauthey Jean-Nicolas
Department of Surgical Oncology, Gastrointestinal Medical Oncology, and Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030-4009, USA.
J Clin Oncol. 2008 Nov 20;26(33):5344-51. doi: 10.1200/JCO.2008.17.5299. Epub 2008 Oct 20.
The primary goal of this study was to evaluate whether pathologic response to chemotherapy predicts patient survival after preoperative chemotherapy and resection of colorectal liver metastases (CLM). The secondary goal of the study was to identify the clinical predictors of pathologic response.
A retrospective review was performed of 305 patients who underwent preoperative irinotecan- or oxaliplatin-based chemotherapy, followed by resection of CLM. Pathologic response was systematically evaluated and reported as the mean of the percentage of cancer cells remaining within each tumor. Univariate and multivariate analyses were performed to identify the predictors of pathologic response and survival.
Cumulative 5-year overall survival rates by pathologic response status were as follows: 75% complete response (no residual cancer cells), 56% major response (1% to 49% residual cancer cells), and 33% minor response (> or = 50% residual cancer cells; complete v major response, P = .037; major v minor response, P = .028). Multivariate analysis revealed that only surgical margin status (P = .050; hazard ratio [HR], 1.77) and pathologic response (major response: P = .034; HR, 4.80; minor response: P = .007; HR, 6.93) were independent predictors of survival. Multivariate analysis of the predictors of pathologic response revealed that carcinoembryonic antigen level < or = 5 ng/mL, tumor size < or = 3 cm, and chemotherapy with fluoropyrimidine plus oxaliplatin and bevacizumab were independent predictors of pathologic response.
Pathologic response predicts survival after preoperative chemotherapy and resection of CLM. Degree of pathologic response represents a new outcome end point for prognosis after resection of CLM.
本研究的主要目标是评估对化疗的病理反应是否能预测结直肠癌肝转移（CLM）患者在术前化疗及切除术后的生存情况。该研究的次要目标是确定病理反应的临床预测因素。
对305例行术前基于伊立替康或奥沙利铂化疗并随后切除CLM的患者进行回顾性分析。系统评估病理反应，并将其报告为每个肿瘤内残留癌细胞百分比的平均值。进行单因素和多因素分析以确定病理反应和生存的预测因素。
根据病理反应状态的累积5年总生存率如下：完全缓解（无残留癌细胞）为75%，主要缓解（残留癌细胞1%至49%）为56%，次要缓解（残留癌细胞≥50%；完全缓解与主要缓解相比，P = 0.037；主要缓解与次要缓解相比，P = 0.028）。多因素分析显示，只有手术切缘状态（P = 0.050；风险比[HR]，1.77）和病理反应（主要缓解：P = 0.034；HR，4.80；次要缓解：P = 0.007；HR，6.93）是生存的独立预测因素。病理反应预测因素的多因素分析显示，癌胚抗原水平≤5 ng/mL、肿瘤大小≤3 cm以及氟尿嘧啶加奥沙利铂和贝伐单抗化疗是病理反应的独立预测因素。
病理反应可预测CLM患者术前化疗及切除术后的生存情况。病理反应程度代表CLM切除术后预后的一个新的结局终点。
