Medical Oncology, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.
Clin Colorectal Cancer. 2012 Jun;11(2):119-26. doi: 10.1016/j.clcc.2011.11.002. Epub 2011 Dec 27.
Intensive medical treatment increases resection rate of liver metastases in patients with metastatic colorectal cancer (MCRC). The effectiveness of liver metastasectomies was evaluated in patients with MCRC who were treated with previously reported FIr-B/FOx (triplet chemotherapy plus bevacizumab).
Fifty patients with MCRC enrolled in the reported phase II study were classified according to involved metastatic sites (liver-only metastatic site, multiple metastatic sites) and the extent of liver metastases (single, multiple). Surgical resectability of liver metastases was evaluated at baseline and every 3 cycles of FIr-B/FOx treatment. The resection rate of liver metastases, activity, and efficacy were evaluated; progression-free survival (PFS) and overall survival (OS) were compared by using the log-rank test.
Patients with liver MCRC were 33 of 50 consecutive unselected patients with MCRC: liver limited, 22 patients; multiple metastatic sites, 11 patients. Liver metastasectomies were performed in 13 patients: 26% of 50 patients with MCRC, 39% of 33 patients with liver MCRC. In patients with liver-only MCRC, a secondary liver surgery was performed in 54%: 6 of 9 single and 6 of 13 multiple liver metastases. Also, 1 liver and lung metastasectomy was performed. Pathologic complete responses were achieved in 2 patients (15%). The conversion rate of unresectable liver metastases was 83%. Objective response rate, PFS, OS were, respectively: 84%, 11 and 23 months in 33 liver MCRC; 86%, 17 and 44 months in 22 liver-limited patients. PFS and OS were significantly increased in patients with liver-limited metastases compared with multiple metastatic sites and single compared with multiple liver metastases.
The FIr-B/FOx regimen may increase the resection rate of liver metastases and improve clinical outcome of patients with liver-only MCRC.
强化治疗可提高转移性结直肠癌（mCRC）患者肝转移灶的切除率。本研究评估了既往报告的 FIr-B/FOx（三联化疗加贝伐单抗）治疗 mCRC 患者中行肝转移灶切除术的疗效。
50 例 mCRC 患者入组该项研究，根据转移部位（肝转移灶、多部位转移灶）和肝转移灶范围（单发、多发）进行分类。在 FIr-B/FOx 治疗每 3 个周期时评估肝转移灶的手术可切除性。评估肝转移灶切除率、活性和疗效；采用对数秩检验比较无进展生存期（PFS）和总生存期（OS）。
50 例 mCRC 患者中 33 例为肝转移灶局限的 mCRC 患者：22 例为单发肝转移灶，11 例为多部位转移灶。13 例患者行肝转移灶切除术：26%的 mCRC 患者，39%的肝转移灶局限 mCRC 患者。在单发肝转移灶局限的患者中，54%行二次肝切除术：9 例单发肝转移灶中 6 例，13 例多发肝转移灶中 6 例。还进行了 1 例肝和肺转移灶切除术。2 例患者（15%）获得病理完全缓解。不可切除肝转移灶的转化率为 83%。33 例肝转移灶局限的 mCRC 患者的客观缓解率、PFS、OS 分别为：84%、11 个月和 23 个月；22 例肝转移灶局限患者分别为：86%、17 个月和 44 个月。与多部位转移灶和多发肝转移灶相比，肝转移灶局限的患者 PFS 和 OS 显著延长。
FIr-B/FOx 方案可提高肝转移灶的切除率，改善单发肝转移灶 mCRC 患者的临床转归。
