Adam René, Wicherts Dennis A, de Haas Robbert J, Ciacio Oriana, Lévi Francis, Paule Bernard, Ducreux Michel, Azoulay Daniel, Bismuth Henri, Castaing Denis
AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire and Department of Medical Oncology, Villejuif, France.
J Clin Oncol. 2009 Apr 10;27(11):1829-35. doi: 10.1200/JCO.2008.19.9273. Epub 2009 Mar 9.
Although oncosurgical strategies have demonstrated increased survival in patients with unresectable colorectal liver metastases (CLM), their potential for cure is still questioned. The aim of this study was to evaluate long-term outcome after combining downsizing chemotherapy and rescue surgery and to define prognostic factors of cure.
All patients with initially unresectable CLM who underwent rescue surgery and had a minimum follow-up of 5 years were included. Cure was defined as a disease-free interval > or = 5 years from last hepatic or extrahepatic resection until last follow-up.
Mean age of 184 patients who underwent resection (April 1988 through July 2002) was 56.9 years. Patients had a mean number of 5.3 metastases (bilobar in 76%), associated to extrahepatic disease in 27%. Surgery was possible after one (74%) or more (26%) lines of chemotherapy. Five- and 10-year overall survival rates were 33% and 27%, respectively. Of 148 patients with a follow-up > or = 5 years, 24 patients (16%) were considered cured (mean follow-up, 118.6 months), six (25%) of whom were considered cured after repeat resection of recurrence. Twelve "cured" patients (50%) had a disease-free interval more than 10 years. Cured patients more often had three or fewer metastases less than 30 mm (P = .03) responding to first-line chemotherapy (P = .05). Multivariate analysis identified maximum size of metastases less than 30 mm at diagnosis, number of metastases at hepatectomy three or fewer, and complete pathologic response as independent predictors of cure.
Cure can be achieved overall in 16% of patients with initially unresectable CLM resected after downsizing chemotherapy. In addition to increased survival, this oncosurgical approach has real potential for disease eradication.
尽管肿瘤外科手术策略已证明可提高不可切除的结直肠癌肝转移（CLM）患者的生存率，但其治愈潜力仍受到质疑。本研究的目的是评估缩小化疗联合挽救性手术后的长期结局，并确定治愈的预后因素。
纳入所有最初不可切除的CLM患者，这些患者接受了挽救性手术且至少随访5年。治愈定义为从最后一次肝切除或肝外切除至最后一次随访的无病间期≥5年。
184例接受手术的患者（1988年4月至2002年7月）的平均年龄为56.9岁。患者平均有5.3个转移灶（76%为双叶转移），27%伴有肝外疾病。在接受一线（74%）或更多线（26%）化疗后可行手术。5年和10年总生存率分别为33%和27%。在148例随访≥5年的患者中，24例（16%）被认为治愈（平均随访118.6个月），其中6例（25%）在复发性肿瘤再次切除后被认为治愈。12例“治愈”患者（50%）的无病间期超过10年。治愈患者更常出现3个或更少、直径小于30 mm的转移灶（P = 0.03），对一线化疗有反应（P = 0.05）。多因素分析确定诊断时转移灶最大直径小于30 mm、肝切除时转移灶数量为3个或更少以及完全病理缓解是治愈的独立预测因素。
最初不可切除的CLM患者在缩小化疗后接受手术，总体治愈率可达16%。除了提高生存率外，这种肿瘤外科手术方法具有真正的疾病根除潜力。
