围手术期使用贝伐单抗对切除的结直肠癌肝转移患者生存的影响：一项肝脏转移瘤调查分析
Impact of peri-operative bevacizumab on survival in patients with resected colorectal liver metastases: an analysis of the LiverMetSurvey.
作者信息
Rong Zhixia, Martel Guillaume, Vandenbroucke-Menu Franck, Adam René, Lapointe Réal
机构信息
Service de chirurgie hépatobiliaire, pancréatique et de transplantation hépatique, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, QC, Canada.
出版信息
HPB (Oxford). 2014 Apr;16(4):342-9. doi: 10.1111/hpb.12138.
BACKGROUND
Peri-operative chemotherapy is recommended for the management of colorectal liver metastases (CRLM). The aim of this study was to examine the impact of peri-operative bevacizumab on survival in patients with resected CRLM.
METHODS
A multicentre retrospective cohort of patients with resected CRLM was analysed from the LiverMetSurvey Registry. Patients who received peri-operative FOLFOX (group A) were compared with those who received peri-operative FOLFOX and bevacizumab (group B).
RESULTS
In total, 501 patients were compared (A, n = 384; B, n = 117). Group A was older (68.3 versus 62.5 years, P < 0.01), had more rectal cancers (30.7 versus 18.8%, P < 0.01) and higher carcinoembryonic antigen (CEA) levels at diagnosis (17.0 versus 9.7 ng/ml, P = 0.043). No difference was observed regarding primary tumour stage, synchronicity and the number or size of metastases. Post-operative infections were more frequent in group B (4.7% versus 12.8%, P < 0.01). Peri-operative bevacizumab had no effect on 3-year overall survival (OS) (76.4% versus 79.8%, P = 0.334), or disease-free survival (DFS) (7.4% versus 7.9%, P = 0.082). DFS was negatively associated with primary tumour node positivity (P = 0.011) and synchronicity (P = 0.041).
CONCLUSIONS
The addition of bevacizumab to standard peri-operative chemotherapy does not appear to be associated with improved OS or DFS in patients with resected CRLM.
背景
围手术期化疗被推荐用于结直肠癌肝转移（CRLM）的治疗。本研究的目的是探讨围手术期使用贝伐单抗对接受CRLM切除术患者生存的影响。
方法
从LiverMetSurvey登记处分析了一组接受CRLM切除术患者的多中心回顾性队列。将接受围手术期FOLFOX方案的患者（A组）与接受围手术期FOLFOX方案联合贝伐单抗的患者（B组）进行比较。
结果
总共比较了501例患者（A组，n = 384；B组，n = 117）。A组患者年龄更大（68.3岁对62.5岁，P < 0.01），直肠癌比例更高（30.7%对18.8%，P < 0.01），诊断时癌胚抗原（CEA）水平更高（17.0对9.7 ng/ml，P = 0.043）。在原发肿瘤分期、同时性以及转移灶的数量和大小方面未观察到差异。B组术后感染更常见（4.7%对12.8%，P < 0.01）。围手术期使用贝伐单抗对3年总生存期（OS）（76.4%对79.8%，P = 0.334）或无病生存期（DFS）（7.4%对7.9%，P = 0.082）无影响。DFS与原发肿瘤淋巴结阳性（P = 0.011）和同时性（P = 0.041）呈负相关。
结论
对于接受CRLM切除术的患者，在标准围手术期化疗中添加贝伐单抗似乎与OS或DFS的改善无关。
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