Dueland Svein, Guren Tormod K, Hagness Morten, Glimelius Bengt, Line Pål-Dag, Pfeiffer Per, Foss Aksel, Tveit Kjell M
*Department of Oncology, Oslo University Hospital, Oslo, Norway †Section for Transplantation Surgery, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway ‡Institute of Clinical Medicine, University of Oslo, Oslo, Norway §Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden; and ¶Department of Oncology, Odense University Hospital, Odense, Denmark.
Ann Surg. 2015 May;261(5):956-60. doi: 10.1097/SLA.0000000000000786.
The primary objective was to compare overall survival (OS) in patients with colorectal cancer (CRC) with nonresectable liver-only metastases treated by liver transplantation or chemotherapy.
CRC is the third most common cancer worldwide. About 50% of patients will develop metastatic disease primarily to the liver and the lung. The majority of patients with liver metastases receive palliative chemotherapy, with a median OS of trial patients of about 2 years, and less than 10% are alive at 5 years.
Patients with nonresectable liver-only CRC metastases underwent liver transplantation in the SECA study (n = 21). Disease-free survival (DFS) and OS of patients included in the SECA study were compared with progression-free survival (PFS) and OS in a similar cohort of CRC patients with liver-only disease included in a first-line chemotherapy study, the NORDIC VII study (n = 47). PFS/DFS and OS were estimated by the Kaplan-Meier method.
DFS/PFS in both groups were 8 to 10 months. However, a dramatic difference in OS was observed. The 5-year OS rate was 56% in patients undergoing liver transplantation compared with 9% in patients starting first-line chemotherapy. The reason for the large difference in OS despite similar DFS/PFS is likely different metastatic patterns at relapse/progression. Relapse in the liver transplantation group was often detected as small, slowly growing lung metastases, whereas progression of nonresectable liver metastases was observed in the chemotherapy group.
Compared with chemotherapy, liver transplantation resulted in a marked increased OS in CRC patients with nonresectable liver-only metastases.
主要目的是比较接受肝移植或化疗的不可切除的单纯肝转移结直肠癌（CRC）患者的总生存期（OS）。
CRC是全球第三大常见癌症。约50%的患者会主要发生肝和肺转移。大多数肝转移患者接受姑息化疗，试验患者的中位OS约为2年，5年生存率低于10%。
在SECA研究中，不可切除的单纯肝转移CRC患者接受了肝移植（n = 21）。将SECA研究中患者的无病生存期（DFS）和OS与一线化疗研究NORDIC VII研究中纳入的类似单纯肝转移CRC患者队列的无进展生存期（PFS）和OS进行比较（n = 47）。采用Kaplan-Meier法估计PFS/DFS和OS。
两组的DFS/PFS均为8至10个月。然而，观察到OS有显著差异。接受肝移植患者的5年OS率为56%，而开始一线化疗的患者为9%。尽管DFS/PFS相似，但OS存在巨大差异的原因可能是复发/进展时转移模式不同。肝移植组的复发常表现为小的、生长缓慢的肺转移，而化疗组则观察到不可切除肝转移的进展。
与化疗相比，肝移植显著提高了不可切除的单纯肝转移CRC患者的OS。
