de Jong Mechteld C, Pulitano Carlo, Ribero Dario, Strub Jennifer, Mentha Gilles, Schulick Richard D, Choti Michael A, Aldrighetti Luca, Capussotti Lorenzo, Pawlik Timothy M
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Ann Surg. 2009 Sep;250(3):440-8. doi: 10.1097/SLA.0b013e3181b4539b.
OBJECTIVE(S): To investigate rates and patterns of recurrence in patients following curative intent surgery for colorectal liver metastasis.
Outcomes following surgical management of colorectal liver metastasis have largely focused on overall survival. Contemporary data on rates and patterns of recurrence following surgery for colorectal liver metastasis are limited.
One thousand six hundred sixty-nine patients treated with surgery (resection +/- radiofrequency ablation [RFA]) for colorectal liver metastasis between 1982 and 2008 were identified from an international multi-institutional database. Clinicopathologic data, recurrence patterns, and recurrence-free survival (RFS) were analyzed.
At the time of the initial liver-directed surgery, surgical treatment was resection only (90.2%), resection plus RFA (8.0%), or RFA alone (1.8%). While 5-year overall survival was 47.3%, 947 (56.7%) patients recurred with a median RFS time of 16.3 months. First recurrence site was intrahepatic only (43.2%), extrahepatic only (35.8%), intra- and extrahepatic (21.0%). There was no difference in RFS based on site of recurrence (intrahepatic: 16.9 months; extrahepatic: 16.6 months; intra- and extrahepatic: 16.2 month; P > 0.05). Receipt of adjuvant chemotherapy was associated with overall recurrence risk (hazard ratio [HR] = 0.56), while history of RFA (HR = 2.39, P = 0.001) and R1 margin status (HR = 1.36) were predictive of intrahepatic recurrence. Pattern of recurrence and RFS remained similar following repeat surgery for recurrent disease.
While 5-year survival following surgery for colorectal liver metastasis approaches 50%, over one-half of patients develop recurrence within 2 years. The pattern of failure is distributed relatively equally among intrahepatic, extrahepatic, and intra- plus extrahepatic sites. Patients undergoing repeat surgery for recurrent metastasis have similar patterns of recurrence and RFS time.
研究结直肠癌肝转移患者行根治性手术后的复发率及复发模式。
结直肠癌肝转移手术治疗的结果主要集中在总生存期。关于结直肠癌肝转移手术后复发率及复发模式的当代数据有限。
从一个国际多机构数据库中识别出1982年至2008年间接受手术（切除±射频消融[RFA]）治疗结直肠癌肝转移的1669例患者。分析临床病理数据、复发模式和无复发生存期（RFS）。
在初次肝脏定向手术时，手术治疗方式仅为切除（90.2%）、切除加RFA（8.0%）或单纯RFA（1.8%）。5年总生存率为47.3%，947例（56.7%）患者复发，中位RFS时间为16.3个月。首次复发部位仅在肝内（43.2%）、仅在肝外（35.8%）、肝内和肝外均有（21.0%）。基于复发部位的RFS无差异（肝内：16.9个月；肝外：16.6个月；肝内和肝外：16.2个月；P>0.05）。接受辅助化疗与总体复发风险相关（风险比[HR]=0.56），而RFA史（HR=2.39，P=0.001）和R1切缘状态（HR=1.36）可预测肝内复发。复发性疾病再次手术后的复发模式和RFS仍然相似。
虽然结直肠癌肝转移手术后5年生存率接近50%，但超过一半的患者在2年内复发。失败模式在肝内、肝外以及肝内和肝外部位相对均匀分布。复发性转移接受再次手术的患者具有相似的复发模式和RFS时间。
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