Department of Surgery, Hepatobiliary Surgery Unit, Scientific Institute San Raffaele, Vita-Salute San Raffaele University, Milan, Italy.
Ann Surg Oncol. 2012 Feb;19(2):435-42. doi: 10.1245/s10434-011-1902-1. Epub 2011 Jul 9.
For patients with colorectal liver metastasis (CLM), the presence of concomitant perihepatic/para-aortic lymph node metastasis (LNM) is considered a contraindication to liver resection. We sought to determine the benefits of liver resection among patients with CLM + LNM by examining long-term outcomes among a large cohort of patients.
Between October 1996 and December 2007, 61 patients with CLM and pathologically proven LNM were identified from an international multi-institutional database of 1629 patients. The effect of LNM, as well as other prognostic factors, on recurrence-free and overall survival was analyzed.
Median overall survival was 32 months, and 1-, 3-, and 5-year overall survival were 86, 35, and 18%, respectively. Five patients were alive and disease-free at last follow-up. Survival was associated with location of LNM. Specifically, 5-year overall survival was 30% among patients with LNM along the hepatoduodenal ligament/retropancreatic area (area 1), 14% among patients with LNM along the common hepatic artery/celiac axis (area 2), and there was only one long-term survivor who experienced recurrent disease among patients who had CLM + para-aortic LNM (area 3) (P = 0.004). On multivariate analyses, overall margin status (hazard ratio [HR] = 2.0), treated number of metastases >6 (HR = 2.3) and para-aortic lymph node involvement (HR = 2.6) each remained significantly associated with increased risk of death (all P < 0.05).
Although overall survival in the setting of LNM is only 18%, certain subsets of patients with LNM can benefit from surgical resection. Specifically, patients with CLM + LNM isolated to area 1 had a 5-year survival of approximately 30%, while long-term survival among patients with para-aortic LNM was rare.
对于结直肠癌肝转移（CLM）患者，合并肝周/腹主动脉旁淋巴结转移（LNM）被认为是肝切除术的禁忌证。我们试图通过检查来自 1629 例患者的国际多机构数据库中的大量患者的长期结果来确定 CLM+LNM 患者行肝切除术的获益。
1996 年 10 月至 2007 年 12 月，从 1629 例患者的国际多机构数据库中确定了 61 例 CLM 且病理证实有 LNM 的患者。分析 LNM 以及其他预后因素对无复发生存和总生存的影响。
中位总生存时间为 32 个月，1、3 和 5 年总生存率分别为 86%、35%和 18%。5 例患者在最后一次随访时仍存活且无疾病。生存与 LNM 的部位有关。具体而言，肝十二指肠韧带/胰后区域（区域 1）LNM 患者的 5 年总生存率为 30%，肝总动脉/腹腔干区域（区域 2）LNM 患者的 14%，仅 1 例发生疾病复发的长期幸存者，该患者为 CLM+腹主动脉旁 LNM（区域 3）（P=0.004）。多变量分析显示，总体切缘状态（危险比[HR] = 2.0）、治疗转移灶数量>6 个（HR = 2.3）和腹主动脉旁淋巴结受累（HR = 2.6）均与死亡风险增加显著相关（均 P < 0.05）。
尽管 LNM 患者的总体生存时间仅为 18%，但某些 LNM 患者亚组可从手术切除中获益。具体来说，CLM+LNM 局限于区域 1 的患者 5 年生存率约为 30%，而腹主动脉旁 LNM 患者的长期生存则罕见。
