Clinical Oncology Department, Infanta Sofía University Hospital, Paseo de Europa 34, San Sebastián de los Reyes, 28702, Madrid, Spain.
Clin Transl Oncol. 2012 Sep;14(9):641-58. doi: 10.1007/s12094-012-0853-8. Epub 2012 Aug 22.
Surgical resection remains the only option of cure for patients with colorectal liver metastases, and no patient should be precluded from surgery. There is much controversy not only regarding the most appropriate therapeutic approach in the neoadjuvant setting but also after surgery is performed. Many patients will experience early relapses but others will be long survivors. We need to establish reliable prognostic and predictive factors to offer a tailored treatment. Several prognostic factors after metastasectomy have been identified: high C-reactive protein levels, a high neutrophil-lymphocyte ratio, elevated neutrophil count and low serum albumin are related to a worst outcome. Elevated CEA and Ki 67 levels, intrahepatic and perihepatic lymph node invasion are also some of the markers related to a worst outcome. In contrast, the administration of preoperative chemotherapy has been associated with a better prognosis after hepatectomy. The administration of adjuvant chemotherapy should be done taking in consideration these factors. Regarding predictive factors, determination of ERCC1, TS, TP and DPD and UGT1 polymorphisms assessment could be considered prior to chemotherapy administration. This would avoid treatment related toxicities and increase this population quality of life.
手术切除仍然是结直肠癌肝转移患者唯一的治愈选择，不应排除任何患者接受手术治疗。不仅在新辅助治疗环境中，而且在手术后也存在很多争议。许多患者会早期复发，但也有很多患者长期生存。我们需要建立可靠的预后和预测因素，以提供个体化的治疗。已经确定了一些转移瘤切除术后的预后因素：高 C 反应蛋白水平、高中性粒细胞-淋巴细胞比值、升高的中性粒细胞计数和低血清白蛋白与预后较差相关。CEA 和 Ki 67 水平升高、肝内和肝周淋巴结侵犯也是与预后较差相关的一些标志物。相反，术前化疗的应用与肝切除术后的更好预后相关。辅助化疗的应用应考虑这些因素。关于预测因素，在给予化疗之前，可以考虑确定 ERCC1、TS、TP 和 DPD 以及 UGT1 多态性评估。这将避免与治疗相关的毒性，并提高该人群的生活质量。
