Kaibori Masaki, Iwamoto Shigeyoshi, Ishizaki Morihiko, Matsui Kosuke, Saito Takamichi, Yoshioka Kazuhiko, Kwon A-Hon Kwon
Dept. of Surgery, Hirakata Hospital, Kansai Medical University.
Gan To Kagaku Ryoho. 2009 Dec;36(13):2579-82.
Recently, an increased number of reports have been published on liver resection following neoadjuvant chemotherapy ( NAC) in patients with initially unresectable colorectal liver metastases (IUCLM). However, the definition of unresectable liver metastases differs among institutions. The size of liver tumor B5 cm and number of tumors B5 is commonly a contraindication for resection of liver metastases. The present study was performed to compare the short and longterm results between patients who underwent liver resection following NAC for IUCLM and those with multiple bilobar metastases for initially resectable liver metastases.
Twenty-seven patients with multiple bilobar liver metastases between 1994 and 2007 were divided into two groups, i. e. 11 patients who underwent liver resection following NAC for IUCLM and 16 patients who initially underwent liver resection. NAC was used in three in J-IFL and eight cases in mFOLFOX6.
All eleven patients with IUCLM were H3/grade C. The median course of NAC was 6 (4-6 courses, Mean+/-SD: 6+/-2 courses). The objective overall response rate was 100% (11/11). H3 of eleven patients was changed to two in H1 and nine in H2 after chemotherapy. Grade C of 11 patients was down-staged in 4 in grade Band 2 in grade A. The H factors and grade of 16 patients who initially underwent liver resection were H16H28H32 and grade A4/B6/C6, respectively. The disease-free and overall survival after resection of colorectal liver metastases between patients with initially unresectable and resectable liver metastases were not significantly different.
NAC enables liver resection in some patients with IUCLM. It should be performed not only preoperatively but also postoperatively for IUCLM because of better survival after surgery.
最近，关于初始不可切除的结直肠癌肝转移（IUCLM）患者新辅助化疗（NAC）后肝切除的报道越来越多。然而，各机构对不可切除肝转移的定义有所不同。肝肿瘤大小≥5 cm和肿瘤数量≥5个通常是肝转移切除的禁忌证。本研究旨在比较IUCLM患者NAC后行肝切除与多叶转移且初始可切除肝转移患者的短期和长期结果。
1994年至2007年间的27例多叶肝转移患者分为两组，即11例IUCLM患者NAC后行肝切除和16例初始行肝切除的患者。NAC在3例患者中用于J-IFL方案，8例患者中用于mFOLFOX6方案。
所有11例IUCLM患者均为H3/ C级。NAC的中位疗程为6（4 - 6个疗程，均值±标准差：6±2个疗程）。客观总缓解率为100%（11/11）。化疗后11例患者的H3级变为2例H1级和9例H2级。11例C级患者中，4例降为B级，2例降为A级。16例初始行肝切除患者的H因子和分级分别为H1 6/H2 8/H3 2和A级4/ B级6/ C级6。初始不可切除和可切除肝转移患者结直肠癌肝转移切除后的无病生存期和总生存期无显著差异。
NAC可使部分IUCLM患者行肝切除。由于术后生存率更高，因此对IUCLM患者不仅应在术前进行NAC，术后也应进行。
