Sorbye Halfdan
Department of Oncology, Haukeland University Hospital, Bergen, Norway,
Recent Results Cancer Res. 2014;203:243-52. doi: 10.1007/978-3-319-08060-4_17.
Recurrence of metastatic disease after resection of liver metastases from colorectal cancer remains a major problem as 70-80 % of patients will have a recurrence, most commonly in the liver or lung. To predict patterns of recurrence and outcome may guide follow-up and further treatment, as patients with recurrence might be candidates for repeated surgery or ablation therapy. A summary of studies shows that after hepatectomy 20-43 % will have a recurrence only in the remaining liver without extrahepatic disease, whereas 15-37 % will have a recurrence only to the lung. Early recurrence is associated with poorer outcome compared to late recurrence. Site of first recurrence after resection of liver metastases is predicted by several baseline variables; synchronous disease, primary tumor site, hepatic tumor size, CEA level, number of hepatic lesions, and RAS mutation status. Pattern of recurrence is a predictor for survival after hepatectomy, with liver-only and lung-only recurrences having the best survival. In the majority of patients with isolated hepatic or lung recurrence, repeated metastasectomy is possible resulting in a 40 % 5-year survival rate. Perioperative chemotherapy reduces the risk of liver recurrence after hepatectomy of colorectal cancer liver metastases.
结直肠癌肝转移灶切除术后转移性疾病的复发仍然是一个主要问题，因为70%-80%的患者会复发，最常见的是在肝脏或肺部。预测复发模式和预后可能会指导随访和进一步治疗，因为复发患者可能是再次手术或消融治疗的候选者。研究总结表明，肝切除术后20%-43%的患者仅在剩余肝脏复发而无肝外疾病，而15%-37%的患者仅肺部复发。与晚期复发相比，早期复发与较差的预后相关。肝转移灶切除术后首次复发的部位可通过几个基线变量预测；同时性疾病、原发肿瘤部位、肝肿瘤大小、癌胚抗原水平、肝内病变数量和RAS突变状态。复发模式是肝切除术后生存的一个预测因素，仅肝脏复发和仅肺部复发的患者生存率最佳。在大多数孤立性肝或肺复发的患者中，再次进行转移灶切除术是可行的，5年生存率为40%。围手术期化疗可降低结直肠癌肝转移灶肝切除术后肝复发的风险。
