Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.
Cancer. 2010 Mar 15;116(6):1502-9. doi: 10.1002/cncr.24912.
During chemotherapy, some colorectal liver metastases (LMs) disappear on serial imaging. This disappearance may represent a complete response (CR) or a reduction in the sensitivity of imaging during chemotherapy. The objective of the current study was to determine the fate of disappearing LMs (DLMs) and the factors that predict a true CR.
Between 2000 and 2003, 435 patients who were evaluated by hepatobiliary surgeons received chemotherapy before they were considered for resection. Inclusion criteria were <12 LMs before chemotherapy, at least 1 DLM on a computed tomography (CT) scan, and either surgical resection or 1 year of clinical follow-up after the disappearance of LMs. A true CR was defined as either a pathologic CR (no tumor detected in the resection specimen) or a durable clinical CR (did not reappear on follow-up imaging). Clinical and pathologic factors were analyzed to identify those associated with a true CR.
During chemotherapy, 39 patients (9%) had a total of 118 DLMs on follow-up CT scans. Sixty-eight DLMs were resected, and 50 were followed clinically. Overall, 75 DLMs (64%) were true CRs, including 44 pathologic CRs and 31 durable clinical CRs. On multivariate analysis, the use of hepatic arterial infusion (HAI) chemotherapy (odds ratio [OR], 6.2; P = .02), the inability to observe the DLM on a magnetic resonance image (OR, 4.7; P = .005), and normalization of serum carcinoembryonic antigen levels (OR, 4.6; P = .006) were associated independently with a true CR.
Approximately 66% of DLMs represented a true CR according to assessment by resection or radiologic follow-up. Predictive factors may help to stratify patients who are likely to harbor residual disease.
在化疗期间，一些结直肠癌肝转移（LM）在连续影像学检查中消失。这种消失可能代表完全缓解（CR）或化疗期间影像学敏感性降低。本研究的目的是确定消失的 LM（DLM）的命运以及预测真正 CR 的因素。
在 2000 年至 2003 年间，接受肝胆外科医生评估的 435 名患者在考虑进行切除术前接受了化疗。纳入标准为化疗前 LM 数<12 个，CT 扫描上至少有 1 个 DLM，且在 LM 消失后进行手术切除或临床随访 1 年。真正的 CR 定义为病理 CR（切除标本中未发现肿瘤）或持久的临床 CR（随访影像学未再出现）。分析临床和病理因素以确定与真正 CR 相关的因素。
在化疗期间，39 名患者（9%）的后续 CT 扫描中有 118 个 DLM。68 个 DLM 被切除，50 个进行了临床随访。总体而言，75 个 DLM（64%）为真正的 CR，包括 44 个病理 CR 和 31 个持久的临床 CR。多变量分析显示，使用肝动脉灌注（HAI）化疗（优势比[OR]，6.2；P=0.02）、磁共振成像（MRI）无法观察到 DLM（OR，4.7；P=0.005）和血清癌胚抗原水平正常化（OR，4.6；P=0.006）与真正的 CR 独立相关。
根据切除或影像学随访评估，约 66%的 DLM 代表真正的 CR。预测因素可能有助于分层残余疾病可能性较大的患者。
