Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Torino, Italy.
Ann Surg Oncol. 2013 Mar;20(3):938-45. doi: 10.1245/s10434-012-2628-4. Epub 2012 Sep 26.
Management of patients with synchronous colorectal liver metastases (SCRLM) should be individually tailored. This study compares patients managed by hepatobiliary centers from diagnosis with those referred for liver resection (LR).
Between 1998 and 2010, a total of 284 patients with SCRLM underwent resection; 106 resectable patients (1-3 unilobar metastases, diameter <100 mm, liver-only disease) were divided into two groups: 66 managed from diagnosis (group A) and 40 referred for LR (group B).
Group A contained a greater proportion of multiple metastases (55.0 vs. 34.8%, P = 0.042). Group B always received colorectal surgery as up-front treatment (vs. 18.2%, P < 0.0001). In group B, chemotherapy before LR was more common (72.5 vs. 33.3%, P = 0.0001) and lasted longer (P = 0.010). More patients in group B exhibited disease progression before LR (17.5 vs. 3.0%, P = 0.025). Group A underwent fewer surgical procedures (80.3% simultaneous resection vs. 0%, P < 0.00001), with similar short-term outcomes. After a median follow-up of 42.0 months, group A exhibited higher 5 year disease-free survival (DFS, 64.8 vs. 30.8%, P = 0.005) and fewer extrahepatic recurrences (21.5 vs. 47.5%, P = 0.005). The late-referral group (>6 months, n = 24) had shorter median overall survival (OS) and DFS than group A (49.1 and 25.3 months vs. not achieved and not achieved, P < 0.05). The early-referral group exhibited OS and DFS similar to group A. Multivariate analysis confirmed late referral as a negative predictive factor of OS and DFS.
Monocentric management of SCRLM in hepatobiliary centers is associated with shorter preoperative chemotherapy, better disease control, fewer surgical procedures (simultaneous resection), and, compared with late-referred patients, better survival.
结直肠肝转移同步患者（SCRLM）的管理应个体化。本研究比较了肝胆中心诊断后管理的患者与转至行肝切除术（LR）的患者。
1998 年至 2010 年间，共 284 例 SCRLM 患者接受了切除术；106 例可切除患者（1-3 个单叶转移灶，直径<100mm，仅肝转移）分为两组：66 例从诊断开始管理（A 组）和 40 例转至行 LR（B 组）。
A 组多发性转移的比例更大（55.0% vs. 34.8%，P=0.042）。B 组始终接受结直肠手术作为一线治疗（18.2%，P<0.0001）。B 组术前 LR 化疗更为常见（72.5% vs. 33.3%，P=0.0001）且持续时间更长（P=0.010）。B 组更多患者在 LR 前出现疾病进展（17.5% vs. 3.0%，P=0.025）。A 组行手术次数更少（80.3%同时切除 vs. 0%，P<0.00001），短期结局相似。中位随访 42.0 个月后，A 组显示出更高的 5 年无疾病生存率（DFS，64.8% vs. 30.8%，P=0.005）和更少的肝外复发（21.5% vs. 47.5%，P=0.005）。延迟转至（>6 个月，n=24）组的中位总生存期（OS）和 DFS 短于 A 组（49.1 和 25.3 个月 vs. 未达到和未达到，P<0.05）。早期转至组的 OS 和 DFS 与 A 组相似。多变量分析证实延迟转至是 OS 和 DFS 的负预测因素。
肝胆中心对 SCRLM 的单中心管理与术前化疗时间更短、疾病控制更好、手术次数更少（同时切除）相关，与延迟转至的患者相比，生存更好。
