Neumann Ulf P, Thelen Armin, Röcken Christoph, Seehofer Daniel, Bahra Marcus, Riess Hanno, Jonas Sven, Schmeding Maximilian, Pratschke Johann, Bova Roberta, Neuhaus Peter
Department of General, Visceral, and Transplantation Surgery, Universitätsklinikum Charité, Campus Virchow-Klinikum, Humboldt-Universität, Berlin, Germany.
Surgery. 2009 Jul;146(1):52-9. doi: 10.1016/j.surg.2009.02.004. Epub 2009 Apr 21.
Liver resection is the only curative treatment offering a chance of long-term survival in patients with colorectal liver metastases (CRM). Recent data indicated that liver resection in patients with tumor progression while receiving chemotherapy was associated with poor outcome. The aim of the study was to identify risk factors for poor outcome in patients with pre-operative chemotherapy of CRM.
We analyzed 160 patients after liver resection for CRM with preoperative systemic. chemotherapy. Three groups of patients were identified: 44 patients (27.5%) had a tumor response, 20 (12.5%) showed stable disease, and 96 (60%) patients had tumor progression while on chemotherapy. Median follow-up was 2.4 years (range, 6 days-11.1 years). All available clinicopathologic variables possibly associated with outcome were evaluated.
Survival was 88%, 53%, and 37% at 1, 3, and 5 years. Noncurative resection, carcinoembryonic antigen levels >200 ng/ml, tumor grading, size of the largest tumor >5 cm, and number of metastases were associated with poor patient outcome. In the multivariate analysis, tumor free margin and tumor grading correlated with the outcome. Tumor progression while on chemotherapy had no influence on the long-term survival.
Liver resection offers a long-term survival benefit for patients with CRM, even when tumor growth proceeds during pre-operative chemotherapy.
肝切除术是为结直肠癌肝转移（CRM）患者提供长期生存机会的唯一根治性治疗方法。近期数据表明，接受化疗期间出现肿瘤进展的患者进行肝切除术后预后较差。本研究的目的是确定CRM患者术前化疗预后不良的危险因素。
我们分析了160例接受术前全身化疗后行肝切除治疗CRM的患者。确定了三组患者：44例（27.5%）有肿瘤反应，20例（12.5%）疾病稳定，96例（60%）患者在化疗期间出现肿瘤进展。中位随访时间为2.4年（范围6天至11.1年）。评估了所有可能与预后相关的临床病理变量。
1年、3年和5年生存率分别为88%、53%和37%。非根治性切除、癌胚抗原水平>200 ng/ml、肿瘤分级、最大肿瘤直径>5 cm以及转移灶数量与患者预后不良相关。多因素分析中，切缘阴性和肿瘤分级与预后相关。化疗期间的肿瘤进展对长期生存无影响。
肝切除术为CRM患者带来长期生存益处，即使术前化疗期间肿瘤仍在生长。
